| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,654 |
3,639 |
$187K |
| D1110 |
Prophylaxis - adult |
1,646 |
1,638 |
$139K |
| D1120 |
Prophylaxis - child |
2,534 |
2,522 |
$95K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
998 |
754 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,853 |
2,836 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,072 |
5,194 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
852 |
848 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
38 |
28 |
$18K |
| D2140 |
|
310 |
213 |
$17K |
| D9430 |
|
436 |
431 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,090 |
1,088 |
$13K |
| D2160 |
|
149 |
132 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
90 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
672 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
80 |
$7K |
| D1206 |
Topical application of fluoride varnish |
438 |
438 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
41 |
$3K |
| D7510 |
|
12 |
12 |
$840.00 |
| D0350 |
|
72 |
61 |
$559.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
33 |
$274.00 |