| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,200 |
3,191 |
$168K |
| D1120 |
Prophylaxis - child |
2,652 |
2,646 |
$97K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,167 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,455 |
4,557 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,980 |
2,966 |
$62K |
| D9430 |
|
1,953 |
1,795 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
521 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,563 |
2,555 |
$30K |
| D4341 |
|
292 |
80 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
281 |
164 |
$19K |
| D2140 |
|
340 |
192 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
385 |
$18K |
| D1206 |
Topical application of fluoride varnish |
969 |
967 |
$16K |
| D1351 |
Sealant - per tooth |
407 |
81 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
762 |
724 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
55 |
$5K |
| D0272 |
Bitewings - two radiographic images |
402 |
401 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
40 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
28 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D1310 |
|
13 |
13 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |