| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,463 |
2,456 |
$132K |
| D1120 |
Prophylaxis - child |
2,270 |
2,259 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
665 |
332 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
287 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,658 |
2,645 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,443 |
1,437 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,820 |
2,800 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
231 |
$12K |
| D2140 |
|
213 |
121 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
99 |
$10K |
| D0350 |
|
924 |
506 |
$9K |
| D1351 |
Sealant - per tooth |
340 |
121 |
$8K |
| D0272 |
Bitewings - two radiographic images |
439 |
437 |
$5K |
| D2160 |
|
63 |
43 |
$5K |
| D7111 |
|
80 |
40 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
91 |
$4K |
| D9993 |
|
60 |
60 |
$4K |
| D9430 |
|
93 |
92 |
$3K |
| D4910 |
|
37 |
37 |
$3K |
| D1310 |
|
60 |
60 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
157 |
$2K |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |