| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,929 |
2,901 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
720 |
400 |
$69K |
| D1120 |
Prophylaxis - child |
2,101 |
2,088 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,662 |
1,631 |
$48K |
| D1110 |
Prophylaxis - adult |
1,216 |
1,190 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
4,090 |
3,839 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
522 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,614 |
1,607 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
535 |
287 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,509 |
1,497 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,756 |
3,222 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
567 |
553 |
$24K |
| D0330 |
Panoramic radiographic image |
502 |
499 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
20 |
12 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
90 |
$10K |
| D1351 |
Sealant - per tooth |
79 |
25 |
$3K |
| D2140 |
|
54 |
42 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D2160 |
|
21 |
14 |
$439.44 |