| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,358 |
2,346 |
$739K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,346 |
1,064 |
$371K |
| D0140 |
Limited oral evaluation - problem focused |
2,303 |
2,192 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
957 |
741 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
790 |
508 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
341 |
$116K |
| D5899 |
|
253 |
171 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
199 |
$75K |
| D2330 |
|
176 |
133 |
$26K |
| D2331 |
|
120 |
93 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
38 |
$12K |
| D1110 |
Prophylaxis - adult |
2,435 |
2,416 |
$371.22 |
| D0274 |
Bitewings - four radiographic images |
1,924 |
1,908 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,016 |
1,953 |
$0.00 |
| D0330 |
Panoramic radiographic image |
532 |
529 |
$0.00 |
| D1120 |
Prophylaxis - child |
337 |
333 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,449 |
1,435 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$0.00 |
| D1351 |
Sealant - per tooth |
64 |
14 |
$0.00 |