| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,234 |
4,164 |
$388K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
785 |
285 |
$40K |
| D1120 |
Prophylaxis - child |
4,190 |
4,122 |
$31K |
| D0274 |
Bitewings - four radiographic images |
2,014 |
1,999 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,999 |
1,965 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
165 |
$18K |
| D1206 |
Topical application of fluoride varnish |
3,906 |
3,841 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
38 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
324 |
128 |
$7K |
| D1351 |
Sealant - per tooth |
208 |
30 |
$6K |
| D0330 |
Panoramic radiographic image |
331 |
329 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
66 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
623 |
608 |
$2K |
| D2140 |
|
32 |
14 |
$615.52 |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
333 |
$238.99 |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
82 |
$0.00 |