| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,749 |
6,747 |
$355K |
| D1120 |
Prophylaxis - child |
6,757 |
6,753 |
$258K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,955 |
1,225 |
$159K |
| D1351 |
Sealant - per tooth |
5,779 |
1,674 |
$145K |
| D0274 |
Bitewings - four radiographic images |
5,287 |
5,283 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,842 |
7,840 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,622 |
7,506 |
$80K |
| D1110 |
Prophylaxis - adult |
807 |
807 |
$70K |
| D2140 |
|
976 |
541 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
528 |
303 |
$34K |
| D0350 |
|
3,386 |
1,275 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
546 |
546 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
239 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,127 |
1,115 |
$13K |
| D0272 |
Bitewings - two radiographic images |
978 |
977 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
25 |
$3K |
| D9430 |
|
15 |
15 |
$480.00 |