| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,107 |
3,058 |
$193K |
| D1120 |
Prophylaxis - child |
3,270 |
3,244 |
$135K |
| D1110 |
Prophylaxis - adult |
1,156 |
1,140 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,551 |
1,549 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,410 |
2,377 |
$49K |
| D1206 |
Topical application of fluoride varnish |
3,454 |
3,416 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
618 |
460 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,172 |
3,410 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
537 |
403 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
559 |
553 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
247 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,688 |
1,648 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
301 |
230 |
$19K |
| D2140 |
|
330 |
273 |
$18K |
| D4910 |
|
160 |
160 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0330 |
Panoramic radiographic image |
277 |
277 |
$5K |
| D2330 |
|
47 |
36 |
$3K |
| D0272 |
Bitewings - two radiographic images |
284 |
284 |
$3K |
| D2160 |
|
40 |
36 |
$3K |
| D4341 |
|
25 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D0350 |
|
19 |
17 |
$117.60 |