| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,078 |
9,966 |
$1.18M |
| D1351 |
Sealant - per tooth |
7,348 |
1,543 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,168 |
1,954 |
$226K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,542 |
2,600 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,082 |
1,066 |
$128K |
| D0272 |
Bitewings - two radiographic images |
6,015 |
5,945 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
905 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,013 |
1,156 |
$75K |
| D1120 |
Prophylaxis - child |
9,288 |
9,195 |
$53K |
| D2140 |
|
2,921 |
1,668 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
9,840 |
9,639 |
$32K |
| D1206 |
Topical application of fluoride varnish |
8,632 |
8,547 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,304 |
3,207 |
$22K |
| D0274 |
Bitewings - four radiographic images |
2,214 |
2,187 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
616 |
344 |
$12K |
| D0330 |
Panoramic radiographic image |
1,030 |
1,024 |
$10K |
| D1110 |
Prophylaxis - adult |
693 |
678 |
$9K |
| D9248 |
|
26 |
25 |
$6K |
| D2332 |
|
127 |
74 |
$6K |
| D2160 |
|
203 |
155 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
79 |
$4K |
| D2331 |
|
41 |
26 |
$4K |