| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,693 |
3,647 |
$195K |
| D1120 |
Prophylaxis - child |
3,257 |
3,212 |
$121K |
| D1110 |
Prophylaxis - adult |
1,300 |
1,289 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
867 |
862 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,890 |
3,855 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,541 |
3,503 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,339 |
3,946 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
312 |
$32K |
| D7111 |
|
349 |
182 |
$20K |
| D1351 |
Sealant - per tooth |
518 |
154 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
175 |
93 |
$12K |
| D1206 |
Topical application of fluoride varnish |
640 |
625 |
$12K |
| D1310 |
|
236 |
236 |
$11K |
| D9993 |
|
109 |
109 |
$7K |
| D2140 |
|
72 |
36 |
$4K |
| D9430 |
|
54 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
92 |
92 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$1K |
| D0601 |
|
56 |
56 |
$840.00 |