| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,957 |
5,926 |
$320K |
| D1110 |
Prophylaxis - adult |
2,345 |
2,329 |
$197K |
| D1120 |
Prophylaxis - child |
4,476 |
4,453 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,886 |
6,659 |
$112K |
| D4910 |
|
1,430 |
1,421 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,366 |
992 |
$77K |
| D0272 |
Bitewings - two radiographic images |
5,659 |
5,626 |
$66K |
| D1206 |
Topical application of fluoride varnish |
4,683 |
4,657 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
901 |
625 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,015 |
693 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
870 |
869 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,989 |
3,656 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
448 |
$45K |
| D2140 |
|
803 |
555 |
$43K |
| D9430 |
|
922 |
881 |
$28K |
| D2330 |
|
355 |
204 |
$25K |
| D4341 |
|
346 |
98 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,743 |
1,736 |
$16K |
| D1351 |
Sealant - per tooth |
514 |
170 |
$11K |
| D2160 |
|
12 |
12 |
$798.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |