| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,273 |
1,258 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,326 |
1,300 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
941 |
928 |
$42K |
| D1120 |
Prophylaxis - child |
939 |
927 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,445 |
1,857 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,170 |
1,162 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
260 |
140 |
$17K |
| D2140 |
|
253 |
133 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
111 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
169 |
84 |
$10K |
| D1206 |
Topical application of fluoride varnish |
846 |
830 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
16 |
12 |
$7K |
| D4910 |
|
81 |
81 |
$6K |
| D1351 |
Sealant - per tooth |
140 |
37 |
$4K |
| D0350 |
|
329 |
125 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
218 |
214 |
$2K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$2K |
| D9430 |
|
39 |
38 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |