| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,025 |
2,020 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,065 |
2,062 |
$134K |
| D1120 |
Prophylaxis - child |
2,855 |
2,850 |
$127K |
| D1110 |
Prophylaxis - adult |
1,023 |
1,020 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,030 |
583 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,340 |
3,594 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,907 |
3,899 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,405 |
2,399 |
$51K |
| D9430 |
|
1,096 |
1,032 |
$35K |
| D0350 |
|
1,121 |
941 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
328 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
155 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
945 |
913 |
$11K |
| D2140 |
|
193 |
126 |
$10K |
| D1310 |
|
199 |
199 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
93 |
$7K |
| D0272 |
Bitewings - two radiographic images |
536 |
536 |
$6K |
| D2160 |
|
76 |
51 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
44 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
46 |
15 |
$2K |
| D9993 |
|
27 |
27 |
$845.00 |
| D0603 |
|
53 |
53 |
$765.00 |
| D1999 |
|
616 |
591 |
$368.00 |
| D0190 |
|
244 |
244 |
$0.00 |