| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,225 |
10,115 |
$851K |
| D1351 |
Sealant - per tooth |
3,779 |
854 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
1,686 |
1,654 |
$129K |
| D1120 |
Prophylaxis - child |
10,226 |
10,094 |
$119K |
| D0272 |
Bitewings - two radiographic images |
8,536 |
8,450 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,271 |
716 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
741 |
$70K |
| D1206 |
Topical application of fluoride varnish |
10,881 |
10,738 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
740 |
475 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,048 |
617 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
683 |
376 |
$28K |
| D0330 |
Panoramic radiographic image |
1,285 |
1,273 |
$25K |
| D2140 |
|
801 |
496 |
$24K |
| D1110 |
Prophylaxis - adult |
855 |
849 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
383 |
121 |
$18K |
| D0274 |
Bitewings - four radiographic images |
818 |
818 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
221 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
320 |
$3K |
| D9420 |
|
50 |
50 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
670 |
664 |
$2K |