| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,519 |
10,342 |
$271K |
| D1110 |
Prophylaxis - adult |
5,775 |
5,664 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,657 |
1,777 |
$215K |
| D1351 |
Sealant - per tooth |
7,603 |
2,230 |
$210K |
| D1120 |
Prophylaxis - child |
6,538 |
6,400 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,639 |
9,453 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,284 |
973 |
$137K |
| D0330 |
Panoramic radiographic image |
2,311 |
2,223 |
$130K |
| D0140 |
Limited oral evaluation - problem focused |
3,649 |
3,348 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,416 |
3,310 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,601 |
1,530 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,786 |
2,724 |
$51K |
| D4355 |
|
717 |
696 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
679 |
431 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
415 |
253 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,373 |
2,213 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,256 |
619 |
$13K |
| D9110 |
|
304 |
289 |
$13K |
| D1206 |
Topical application of fluoride varnish |
709 |
682 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
127 |
$9K |
| D2335 |
|
54 |
44 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
26 |
$5K |
| D0250 |
|
218 |
213 |
$5K |
| D2140 |
|
21 |
16 |
$1K |
| D1354 |
|
52 |
25 |
$392.36 |
| D1999 |
|
15 |
15 |
$0.00 |
| D9907 |
|
33 |
33 |
$0.00 |