| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,416 |
2,395 |
$142K |
| D1120 |
Prophylaxis - child |
2,441 |
2,422 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,251 |
1,240 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
335 |
158 |
$22K |
| D1351 |
Sealant - per tooth |
673 |
103 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
172 |
$15K |
| D1206 |
Topical application of fluoride varnish |
2,508 |
2,486 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
566 |
537 |
$13K |
| D0274 |
Bitewings - four radiographic images |
252 |
244 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
24 |
$6K |
| D2140 |
|
23 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
164 |
$881.75 |
| D1110 |
Prophylaxis - adult |
37 |
37 |
$626.48 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$0.00 |