| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,940 |
5,936 |
$309K |
| D1120 |
Prophylaxis - child |
6,425 |
6,412 |
$237K |
| D1351 |
Sealant - per tooth |
6,007 |
1,392 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,522 |
2,517 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,326 |
7,310 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,890 |
1,886 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,102 |
661 |
$73K |
| D1110 |
Prophylaxis - adult |
725 |
724 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,433 |
2,432 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
778 |
367 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,290 |
5,682 |
$41K |
| D9430 |
|
914 |
870 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,145 |
2,097 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,253 |
1,252 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
216 |
147 |
$14K |
| D1310 |
|
327 |
327 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
171 |
171 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
49 |
$8K |
| D9993 |
|
194 |
194 |
$6K |
| D0603 |
|
281 |
281 |
$4K |
| D0240 |
|
355 |
182 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$918.40 |
| D1999 |
|
389 |
387 |
$0.00 |