| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,230 |
3,211 |
$79K |
| D1120 |
Prophylaxis - child |
2,072 |
2,054 |
$75K |
| D1110 |
Prophylaxis - adult |
1,400 |
1,396 |
$61K |
| D1206 |
Topical application of fluoride varnish |
1,551 |
1,539 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,089 |
1,082 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
39 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
249 |
248 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
241 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$602.00 |