| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,164 |
1,149 |
$28K |
| D1110 |
Prophylaxis - adult |
609 |
602 |
$22K |
| D1120 |
Prophylaxis - child |
696 |
681 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,027 |
1,007 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
308 |
299 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
82 |
$9K |
| D0274 |
Bitewings - four radiographic images |
294 |
289 |
$9K |
| D1351 |
Sealant - per tooth |
275 |
80 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
447 |
429 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
91 |
$4K |
| D0330 |
Panoramic radiographic image |
60 |
59 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
119 |
$3K |
| D0272 |
Bitewings - two radiographic images |
169 |
163 |
$3K |
| D2140 |
|
17 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$998.20 |