| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
4,033 |
3,999 |
$256K |
| D1206 |
Topical application of fluoride varnish |
4,406 |
4,381 |
$166K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,046 |
465 |
$63K |
| D1120 |
Prophylaxis - child |
4,567 |
4,535 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
454 |
132 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
4,259 |
4,233 |
$43K |
| D1351 |
Sealant - per tooth |
871 |
260 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,621 |
3,595 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
106 |
$20K |
| D0274 |
Bitewings - four radiographic images |
285 |
285 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
66 |
$14K |
| D2140 |
|
237 |
136 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,319 |
3,305 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
624 |
$10K |
| D0330 |
Panoramic radiographic image |
400 |
400 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
110 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
371 |
364 |
$2K |