| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,446 |
13,354 |
$367K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,609 |
2,623 |
$312K |
| D1206 |
Topical application of fluoride varnish |
15,081 |
14,902 |
$302K |
| D1351 |
Sealant - per tooth |
13,433 |
3,115 |
$298K |
| D1120 |
Prophylaxis - child |
12,429 |
12,327 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,207 |
1,818 |
$218K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,588 |
5,523 |
$163K |
| D1110 |
Prophylaxis - adult |
2,849 |
2,814 |
$112K |
| D0274 |
Bitewings - four radiographic images |
6,199 |
6,140 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,333 |
811 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
8,830 |
8,685 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,798 |
1,751 |
$72K |
| D0240 |
|
8,262 |
4,092 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,051 |
998 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,568 |
7,894 |
$20K |
| D1999 |
|
1,235 |
1,146 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
97 |
$9K |
| D2140 |
|
168 |
82 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
27 |
$3K |