| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,120 |
8,083 |
$616K |
| D1351 |
Sealant - per tooth |
9,001 |
1,941 |
$269K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,937 |
918 |
$139K |
| D1120 |
Prophylaxis - child |
8,197 |
8,161 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
6,442 |
6,394 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
781 |
778 |
$59K |
| D0272 |
Bitewings - two radiographic images |
5,152 |
5,123 |
$56K |
| D1206 |
Topical application of fluoride varnish |
8,609 |
8,576 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
318 |
$53K |
| D2140 |
|
842 |
550 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
486 |
285 |
$33K |
| D0330 |
Panoramic radiographic image |
1,056 |
1,055 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
117 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,980 |
3,857 |
$7K |
| D0274 |
Bitewings - four radiographic images |
883 |
876 |
$6K |
| D9248 |
|
237 |
220 |
$3K |
| D1110 |
Prophylaxis - adult |
301 |
298 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
71 |
$2K |
| D0240 |
|
85 |
44 |
$142.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
52 |
$33.74 |