| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,802 |
4,768 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
5,459 |
5,359 |
$226K |
| D0272 |
Bitewings - two radiographic images |
3,658 |
3,606 |
$156K |
| D1351 |
Sealant - per tooth |
7,793 |
1,451 |
$152K |
| D1120 |
Prophylaxis - child |
5,920 |
5,866 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,221 |
1,206 |
$80K |
| D1206 |
Topical application of fluoride varnish |
6,074 |
5,993 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,121 |
1,108 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,346 |
5,186 |
$51K |
| D0330 |
Panoramic radiographic image |
849 |
845 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,084 |
445 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
419 |
174 |
$28K |
| D9420 |
|
92 |
92 |
$25K |
| D2140 |
|
527 |
259 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
50 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
80 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$2K |
| D1110 |
Prophylaxis - adult |
27 |
25 |
$875.23 |
| D1208 |
Topical application of fluoride, excluding varnish |
144 |
144 |
$19.00 |