| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,099 |
9,030 |
$493K |
| D1120 |
Prophylaxis - child |
10,786 |
10,705 |
$424K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,263 |
1,728 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,025 |
3,005 |
$197K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,225 |
11,145 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,449 |
1,387 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,660 |
6,301 |
$92K |
| D1110 |
Prophylaxis - adult |
942 |
930 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
5,989 |
5,872 |
$71K |
| D1310 |
|
1,009 |
1,008 |
$46K |
| D9993 |
|
570 |
570 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
299 |
209 |
$23K |
| D0274 |
Bitewings - four radiographic images |
944 |
938 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
324 |
192 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
367 |
365 |
$17K |
| D1351 |
Sealant - per tooth |
711 |
159 |
$17K |
| D0350 |
|
1,564 |
628 |
$14K |
| D0601 |
|
795 |
794 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
133 |
61 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
89 |
87 |
$1K |
| D0603 |
|
82 |
82 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$1K |
| D1354 |
|
26 |
26 |
$700.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |