| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,929 |
3,882 |
$253K |
| D1120 |
Prophylaxis - child |
4,109 |
4,062 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,643 |
1,633 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,820 |
4,530 |
$102K |
| D1110 |
Prophylaxis - adult |
995 |
988 |
$88K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,185 |
728 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
880 |
879 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,004 |
2,974 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
369 |
$33K |
| D2140 |
|
600 |
365 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,341 |
2,324 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,842 |
1,830 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,185 |
1,184 |
$14K |
| D1310 |
|
161 |
161 |
$7K |
| D9993 |
|
87 |
85 |
$4K |
| D4910 |
|
25 |
25 |
$2K |
| D0603 |
|
100 |
99 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
14 |
$1K |
| D7111 |
|
18 |
13 |
$1K |
| D2160 |
|
12 |
12 |
$957.60 |
| D1320 |
|
24 |
24 |
$382.50 |