| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,430 |
4,416 |
$345K |
| D1351 |
Sealant - per tooth |
4,668 |
1,340 |
$112K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,317 |
611 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,019 |
488 |
$87K |
| D1120 |
Prophylaxis - child |
4,910 |
4,894 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,927 |
3,911 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
588 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
626 |
374 |
$48K |
| D2140 |
|
592 |
352 |
$40K |
| D1206 |
Topical application of fluoride varnish |
4,966 |
4,951 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,716 |
2,688 |
$17K |
| D0274 |
Bitewings - four radiographic images |
509 |
507 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,348 |
2,302 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
288 |
284 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$3K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$1K |