| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,116 |
8,069 |
$230K |
| D1120 |
Prophylaxis - child |
5,287 |
5,251 |
$187K |
| D1110 |
Prophylaxis - adult |
3,604 |
3,567 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,757 |
5,715 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
955 |
627 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,440 |
3,407 |
$76K |
| D2140 |
|
529 |
320 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
597 |
584 |
$27K |
| D0330 |
Panoramic radiographic image |
444 |
440 |
$25K |
| D1206 |
Topical application of fluoride varnish |
832 |
827 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
126 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
40 |
$4K |
| D2160 |
|
15 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$946.40 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$330.00 |