| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,334 |
4,318 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,269 |
7,072 |
$152K |
| D1120 |
Prophylaxis - child |
3,817 |
3,804 |
$138K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,967 |
1,230 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,573 |
1,572 |
$100K |
| D2140 |
|
1,601 |
1,040 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,945 |
3,935 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,734 |
3,721 |
$41K |
| D0350 |
|
2,534 |
1,565 |
$24K |
| D1351 |
Sealant - per tooth |
969 |
345 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,553 |
1,550 |
$18K |
| D4341 |
|
200 |
65 |
$14K |
| D9430 |
|
391 |
377 |
$12K |
| D1110 |
Prophylaxis - adult |
84 |
84 |
$7K |
| D2160 |
|
74 |
63 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
29 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
20 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$861.00 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$492.00 |