| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,152 |
4,150 |
$334K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
588 |
$60K |
| D1120 |
Prophylaxis - child |
4,729 |
4,725 |
$56K |
| D1206 |
Topical application of fluoride varnish |
4,941 |
4,939 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,699 |
2,696 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
360 |
222 |
$21K |
| D1351 |
Sealant - per tooth |
619 |
105 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
92 |
$16K |
| D0274 |
Bitewings - four radiographic images |
374 |
374 |
$6K |
| D2140 |
|
90 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
587 |
577 |
$4K |
| D0330 |
Panoramic radiographic image |
160 |
160 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$761.14 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$402.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
180 |
171 |
$342.17 |