| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,930 |
2,907 |
$347K |
| D0220 |
Intraoral - periapical first radiographic image |
1,974 |
1,910 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
409 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
106 |
$12K |
| D1110 |
Prophylaxis - adult |
415 |
411 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,022 |
1,011 |
$8K |
| D1351 |
Sealant - per tooth |
253 |
46 |
$7K |
| D2140 |
|
242 |
154 |
$6K |
| D1120 |
Prophylaxis - child |
2,324 |
2,303 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
190 |
127 |
$6K |
| D1206 |
Topical application of fluoride varnish |
2,762 |
2,741 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,601 |
1,300 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
24 |
$3K |
| D2950 |
|
28 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
810 |
799 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$311.03 |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$279.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
93 |
92 |
$212.47 |