| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,406 |
5,403 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,923 |
917 |
$164K |
| D1120 |
Prophylaxis - child |
5,042 |
5,040 |
$93K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,590 |
820 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,470 |
3,465 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
766 |
766 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,060 |
642 |
$71K |
| D1351 |
Sealant - per tooth |
1,231 |
315 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
5,927 |
5,884 |
$45K |
| D2140 |
|
969 |
576 |
$38K |
| D1206 |
Topical application of fluoride varnish |
4,660 |
4,659 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,458 |
1,457 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
517 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,247 |
3,207 |
$30K |
| D0330 |
Panoramic radiographic image |
573 |
573 |
$20K |
| D1110 |
Prophylaxis - adult |
341 |
341 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
135 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
66 |
$9K |
| D2332 |
|
25 |
13 |
$2K |
| D2330 |
|
21 |
12 |
$2K |
| D2331 |
|
13 |
12 |
$1K |
| D1999 |
|
18 |
18 |
$54.00 |