| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,057 |
4,043 |
$243K |
| D1110 |
Prophylaxis - adult |
2,352 |
2,347 |
$199K |
| D1120 |
Prophylaxis - child |
3,572 |
3,559 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,039 |
2,038 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,614 |
4,634 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,720 |
1,719 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,248 |
723 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,834 |
5,823 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,011 |
504 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,782 |
2,776 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
615 |
334 |
$35K |
| D9430 |
|
1,034 |
989 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
310 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
282 |
214 |
$21K |
| D2140 |
|
385 |
243 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,112 |
1,110 |
$13K |
| D0350 |
|
1,365 |
694 |
$11K |
| D4910 |
|
80 |
80 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
348 |
$4K |
| D1351 |
Sealant - per tooth |
100 |
28 |
$4K |
| D4341 |
|
48 |
14 |
$3K |
| D2160 |
|
16 |
12 |
$1K |
| D0270 |
|
12 |
12 |
$60.00 |