| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,287 |
3,273 |
$183K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,807 |
774 |
$120K |
| D1120 |
Prophylaxis - child |
3,159 |
3,147 |
$118K |
| D1110 |
Prophylaxis - adult |
1,153 |
1,148 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,053 |
3,554 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,567 |
532 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,032 |
1,030 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,397 |
2,386 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,358 |
4,338 |
$50K |
| D1351 |
Sealant - per tooth |
1,205 |
399 |
$31K |
| D9430 |
|
879 |
790 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
525 |
525 |
$25K |
| D0350 |
|
2,303 |
1,155 |
$22K |
| D4910 |
|
155 |
154 |
$12K |
| D2160 |
|
142 |
93 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
59 |
$9K |
| D2140 |
|
155 |
85 |
$8K |
| D0272 |
Bitewings - two radiographic images |
633 |
630 |
$7K |
| D2330 |
|
25 |
15 |
$2K |