| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,765 |
4,754 |
$560K |
| D9248 |
|
391 |
385 |
$170K |
| D0272 |
Bitewings - two radiographic images |
4,393 |
4,378 |
$71K |
| D1120 |
Prophylaxis - child |
4,995 |
4,982 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
290 |
$43K |
| D1351 |
Sealant - per tooth |
1,357 |
367 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
181 |
$30K |
| D1206 |
Topical application of fluoride varnish |
5,072 |
5,059 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,845 |
4,814 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
566 |
244 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
200 |
76 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
85 |
$7K |
| D0330 |
Panoramic radiographic image |
650 |
650 |
$7K |
| D2140 |
|
260 |
123 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
75 |
$1K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$0.00 |