| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,936 |
18,060 |
$479K |
| D1120 |
Prophylaxis - child |
13,831 |
13,199 |
$364K |
| D1206 |
Topical application of fluoride varnish |
22,008 |
20,951 |
$346K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,855 |
2,429 |
$288K |
| D1110 |
Prophylaxis - adult |
7,496 |
7,073 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,153 |
1,604 |
$216K |
| D0220 |
Intraoral - periapical first radiographic image |
11,848 |
11,208 |
$172K |
| D1351 |
Sealant - per tooth |
5,965 |
1,930 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,941 |
10,147 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,984 |
3,750 |
$119K |
| D0330 |
Panoramic radiographic image |
1,945 |
1,807 |
$99K |
| D0272 |
Bitewings - two radiographic images |
5,519 |
5,281 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
1,460 |
$65K |
| D1354 |
|
12,774 |
3,160 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
189 |
155 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
433 |
397 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
188 |
109 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
26 |
$3K |
| D9995 |
|
63 |
59 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| 99199 |
Unlisted special service, procedure or report |
38 |
38 |
$210.00 |