| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,004 |
7,938 |
$648K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,313 |
1,287 |
$140K |
| D1120 |
Prophylaxis - child |
8,767 |
8,681 |
$110K |
| D1351 |
Sealant - per tooth |
3,238 |
815 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,918 |
790 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
901 |
345 |
$82K |
| D0272 |
Bitewings - two radiographic images |
6,467 |
6,393 |
$59K |
| D2140 |
|
1,142 |
585 |
$56K |
| D1206 |
Topical application of fluoride varnish |
9,018 |
8,928 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
475 |
142 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,645 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
148 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
515 |
261 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,568 |
1,538 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
175 |
$9K |
| D1110 |
Prophylaxis - adult |
347 |
342 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,000 |
960 |
$4K |
| D0330 |
Panoramic radiographic image |
398 |
391 |
$3K |
| D1999 |
|
13 |
12 |
$0.00 |