| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,904 |
8,884 |
$401K |
| D1120 |
Prophylaxis - child |
8,015 |
7,998 |
$290K |
| D1110 |
Prophylaxis - adult |
2,658 |
2,650 |
$206K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,150 |
2,064 |
$204K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,271 |
10,924 |
$201K |
| D1351 |
Sealant - per tooth |
6,960 |
2,146 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,486 |
2,479 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,876 |
10,849 |
$127K |
| D2140 |
|
2,429 |
1,548 |
$126K |
| D0274 |
Bitewings - four radiographic images |
4,139 |
4,127 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,543 |
1,542 |
$72K |
| D0272 |
Bitewings - two radiographic images |
4,554 |
4,547 |
$52K |
| D0350 |
|
3,773 |
3,343 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,033 |
2,884 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
613 |
351 |
$32K |
| D9430 |
|
858 |
832 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
172 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
92 |
$10K |
| D2160 |
|
123 |
96 |
$10K |
| D4341 |
|
97 |
26 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
74 |
74 |
$5K |
| D2330 |
|
19 |
12 |
$1K |
| D0270 |
|
37 |
36 |
$178.75 |