| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,799 |
4,784 |
$250K |
| D1120 |
Prophylaxis - child |
4,554 |
4,546 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,032 |
1,227 |
$136K |
| D1110 |
Prophylaxis - adult |
1,276 |
1,276 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,135 |
658 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,466 |
5,542 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,178 |
712 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,886 |
5,878 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,054 |
1,054 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
985 |
543 |
$54K |
| D2160 |
|
648 |
394 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,264 |
2,255 |
$48K |
| D0350 |
|
4,113 |
1,919 |
$40K |
| D2140 |
|
637 |
313 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,635 |
2,540 |
$31K |
| D2394 |
|
279 |
206 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
505 |
$23K |
| D1310 |
|
438 |
434 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
165 |
$15K |
| D4341 |
|
194 |
84 |
$11K |
| D9993 |
|
174 |
174 |
$11K |
| D0272 |
Bitewings - two radiographic images |
915 |
915 |
$11K |
| D9430 |
|
285 |
282 |
$9K |
| D1351 |
Sealant - per tooth |
221 |
58 |
$8K |
| D4910 |
|
98 |
98 |
$8K |
| D0603 |
|
167 |
167 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$767.00 |
| D0270 |
|
12 |
12 |
$60.00 |