| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,959 |
8,905 |
$831K |
| D1351 |
Sealant - per tooth |
9,120 |
1,771 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,312 |
1,305 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,715 |
1,424 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,386 |
716 |
$122K |
| D0272 |
Bitewings - two radiographic images |
6,363 |
6,315 |
$106K |
| D1120 |
Prophylaxis - child |
8,573 |
8,515 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
9,191 |
9,085 |
$81K |
| D1206 |
Topical application of fluoride varnish |
9,933 |
9,866 |
$59K |
| D2140 |
|
1,446 |
834 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
619 |
353 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
436 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,927 |
1,918 |
$39K |
| D0330 |
Panoramic radiographic image |
2,048 |
2,037 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,638 |
8,569 |
$31K |
| D1110 |
Prophylaxis - adult |
571 |
569 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
27 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
115 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
97 |
$188.00 |