| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,879 |
4,852 |
$400K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
849 |
395 |
$64K |
| D1120 |
Prophylaxis - child |
4,831 |
4,809 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
191 |
$42K |
| D1351 |
Sealant - per tooth |
1,318 |
304 |
$39K |
| D2140 |
|
566 |
298 |
$34K |
| D1206 |
Topical application of fluoride varnish |
5,052 |
5,028 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
266 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,917 |
2,842 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
139 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,417 |
2,401 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,631 |
2,430 |
$15K |
| D0274 |
Bitewings - four radiographic images |
803 |
792 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
38 |
$4K |
| D0330 |
Panoramic radiographic image |
84 |
83 |
$3K |
| D1110 |
Prophylaxis - adult |
169 |
158 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$344.10 |
| D9248 |
|
13 |
12 |
$251.37 |