| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,257 |
3,256 |
$39K |
| D1110 |
Prophylaxis - adult |
2,100 |
2,095 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
2,046 |
1,979 |
$24K |
| D0274 |
Bitewings - four radiographic images |
2,812 |
2,811 |
$23K |
| D1120 |
Prophylaxis - child |
1,889 |
1,887 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
699 |
544 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,187 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,867 |
1,865 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
352 |
296 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
325 |
259 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,779 |
2,699 |
$9K |
| D1351 |
Sealant - per tooth |
1,268 |
336 |
$9K |
| D0330 |
Panoramic radiographic image |
992 |
991 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
233 |
$8K |
| D2140 |
|
322 |
256 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,405 |
1,389 |
$6K |
| D4355 |
|
144 |
144 |
$3K |
| D0272 |
Bitewings - two radiographic images |
483 |
482 |
$2K |
| D2331 |
|
71 |
62 |
$2K |
| D2330 |
|
32 |
25 |
$693.00 |
| D0431 |
|
485 |
482 |
$0.00 |
| D1999 |
|
166 |
109 |
$0.00 |