| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,526 |
6,508 |
$368K |
| D1120 |
Prophylaxis - child |
6,727 |
6,700 |
$260K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,444 |
1,420 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,354 |
8,350 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,666 |
1,656 |
$105K |
| D1206 |
Topical application of fluoride varnish |
8,346 |
8,312 |
$101K |
| D1110 |
Prophylaxis - adult |
1,174 |
1,171 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,078 |
666 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,051 |
3,048 |
$65K |
| D2140 |
|
913 |
637 |
$47K |
| D9110 |
|
735 |
720 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,772 |
2,751 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
570 |
342 |
$32K |
| D2160 |
|
241 |
173 |
$18K |
| D1351 |
Sealant - per tooth |
553 |
245 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
193 |
$14K |
| D9993 |
|
255 |
255 |
$12K |
| D1310 |
|
255 |
255 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
157 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
512 |
509 |
$5K |
| D2330 |
|
40 |
25 |
$3K |
| D9430 |
|
57 |
55 |
$2K |
| D0603 |
|
37 |
37 |
$495.00 |
| D0350 |
|
18 |
12 |
$172.80 |
| D0270 |
|
24 |
24 |
$120.00 |
| D3120 |
|
240 |
132 |
$0.00 |