| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,487 |
4,481 |
$382K |
| D0272 |
Bitewings - two radiographic images |
2,926 |
2,913 |
$90K |
| D1120 |
Prophylaxis - child |
4,145 |
4,140 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
809 |
401 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,784 |
3,765 |
$56K |
| D1206 |
Topical application of fluoride varnish |
4,361 |
4,354 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,468 |
3,609 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
516 |
333 |
$37K |
| D0330 |
Panoramic radiographic image |
900 |
900 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
1,041 |
$26K |
| D1351 |
Sealant - per tooth |
1,086 |
213 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
565 |
306 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$12K |
| D2140 |
|
274 |
179 |
$11K |
| D1110 |
Prophylaxis - adult |
207 |
207 |
$10K |
| D9420 |
|
113 |
113 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
62 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$505.27 |
| D1208 |
Topical application of fluoride, excluding varnish |
157 |
157 |
$0.00 |