| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,369 |
4,348 |
$219K |
| D1120 |
Prophylaxis - child |
5,361 |
5,342 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,750 |
1,140 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,474 |
3,464 |
$73K |
| D1206 |
Topical application of fluoride varnish |
4,024 |
4,010 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,319 |
4,589 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
660 |
459 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
704 |
697 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
185 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
182 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,320 |
1,315 |
$12K |
| D0272 |
Bitewings - two radiographic images |
680 |
680 |
$8K |
| D2160 |
|
84 |
71 |
$7K |
| D0350 |
|
683 |
420 |
$6K |
| D2330 |
|
67 |
51 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
35 |
$4K |
| D1352 |
|
89 |
28 |
$2K |
| D9430 |
|
58 |
52 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
93 |
86 |
$958.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$455.00 |
| D1999 |
|
45 |
41 |
$26.00 |