| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,488 |
5,431 |
$445K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,827 |
905 |
$121K |
| D1351 |
Sealant - per tooth |
2,589 |
733 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,501 |
755 |
$83K |
| D1120 |
Prophylaxis - child |
4,995 |
4,940 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
675 |
$70K |
| D2140 |
|
1,672 |
820 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,937 |
3,858 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,219 |
733 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,894 |
4,796 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,449 |
1,446 |
$30K |
| D1206 |
Topical application of fluoride varnish |
4,041 |
4,008 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,990 |
2,876 |
$24K |
| D1110 |
Prophylaxis - adult |
961 |
947 |
$20K |
| D0330 |
Panoramic radiographic image |
734 |
729 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
133 |
38 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
42 |
$930.57 |
| D1999 |
|
284 |
282 |
$813.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
162 |
$62.62 |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
96 |
$0.00 |