| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,261 |
3,224 |
$273K |
| D1120 |
Prophylaxis - child |
3,474 |
3,432 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
593 |
231 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
258 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,849 |
1,825 |
$20K |
| D1206 |
Topical application of fluoride varnish |
3,262 |
3,223 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,715 |
1,655 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
57 |
$10K |
| D1351 |
Sealant - per tooth |
148 |
29 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,581 |
1,190 |
$6K |
| D2140 |
|
131 |
53 |
$5K |
| D0274 |
Bitewings - four radiographic images |
477 |
465 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
84 |
$4K |
| D0330 |
Panoramic radiographic image |
107 |
106 |
$3K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$665.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
12 |
$0.00 |