| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,796 |
2,764 |
$358K |
| D0140 |
Limited oral evaluation - problem focused |
581 |
551 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
570 |
354 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
134 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
99 |
$17K |
| D1351 |
Sealant - per tooth |
803 |
112 |
$16K |
| D2140 |
|
160 |
121 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
71 |
$11K |
| D1110 |
Prophylaxis - adult |
1,320 |
1,303 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,926 |
1,864 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,844 |
1,818 |
$5K |
| D1206 |
Topical application of fluoride varnish |
2,519 |
2,490 |
$5K |
| D1120 |
Prophylaxis - child |
1,630 |
1,611 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
459 |
456 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,645 |
1,341 |
$735.64 |
| D0272 |
Bitewings - two radiographic images |
190 |
186 |
$122.90 |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$0.00 |