| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,287 |
6,287 |
$172K |
| D1120 |
Prophylaxis - child |
4,752 |
4,751 |
$118K |
| D1206 |
Topical application of fluoride varnish |
6,895 |
6,892 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,004 |
3,004 |
$74K |
| D1110 |
Prophylaxis - adult |
2,069 |
2,067 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
834 |
449 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,585 |
3,543 |
$37K |
| D1354 |
|
4,982 |
1,319 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,722 |
3,137 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
351 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
453 |
$18K |
| D0272 |
Bitewings - two radiographic images |
878 |
877 |
$15K |
| D1351 |
Sealant - per tooth |
648 |
329 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D2160 |
|
17 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$567.84 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$349.44 |
| D9985 |
|
273 |
255 |
$0.00 |
| D1999 |
|
19 |
19 |
$0.00 |