| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,903 |
6,887 |
$384K |
| D1120 |
Prophylaxis - child |
8,400 |
8,373 |
$325K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,461 |
8,433 |
$103K |
| D0274 |
Bitewings - four radiographic images |
4,392 |
4,385 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,365 |
7,376 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
443 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
537 |
325 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
508 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,804 |
1,800 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
114 |
$9K |
| D1110 |
Prophylaxis - adult |
104 |
104 |
$9K |
| D1351 |
Sealant - per tooth |
293 |
99 |
$7K |
| D1310 |
|
142 |
141 |
$6K |
| D0350 |
|
566 |
310 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
51 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$3K |
| D9993 |
|
128 |
128 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
76 |
$895.50 |
| D2140 |
|
15 |
12 |
$819.00 |
| D9430 |
|
25 |
24 |
$752.00 |