| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,228 |
3,212 |
$204K |
| D1120 |
Prophylaxis - child |
3,956 |
3,947 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,247 |
1,236 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,216 |
2,206 |
$140K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,775 |
1,037 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,801 |
4,647 |
$112K |
| D0350 |
|
9,633 |
3,482 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,700 |
928 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,107 |
716 |
$87K |
| D2140 |
|
1,302 |
746 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,763 |
2,750 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,163 |
4,148 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,022 |
1,022 |
$48K |
| D1110 |
Prophylaxis - adult |
539 |
535 |
$45K |
| D9430 |
|
1,009 |
955 |
$32K |
| D2160 |
|
364 |
264 |
$29K |
| D2330 |
|
335 |
178 |
$26K |
| D1351 |
Sealant - per tooth |
888 |
264 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,134 |
1,106 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
136 |
$12K |
| D0272 |
Bitewings - two radiographic images |
380 |
380 |
$5K |
| D2394 |
|
28 |
24 |
$2K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$860.00 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$510.00 |
| D1320 |
|
14 |
14 |
$45.00 |