| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,478 |
4,415 |
$373K |
| D1120 |
Prophylaxis - child |
4,639 |
4,550 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
441 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
873 |
433 |
$49K |
| D0272 |
Bitewings - two radiographic images |
3,338 |
3,275 |
$43K |
| D1351 |
Sealant - per tooth |
1,025 |
247 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
172 |
$32K |
| D1206 |
Topical application of fluoride varnish |
4,921 |
4,839 |
$31K |
| D0274 |
Bitewings - four radiographic images |
989 |
981 |
$16K |
| D0330 |
Panoramic radiographic image |
454 |
441 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
706 |
695 |
$7K |
| D1110 |
Prophylaxis - adult |
144 |
144 |
$3K |
| D2160 |
|
19 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
248 |
237 |
$1K |
| D2140 |
|
59 |
36 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$469.82 |