| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,275 |
1,259 |
$74K |
| D0272 |
Bitewings - two radiographic images |
821 |
802 |
$53K |
| D1120 |
Prophylaxis - child |
1,463 |
1,445 |
$22K |
| D0274 |
Bitewings - four radiographic images |
545 |
543 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
168 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,543 |
1,523 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
24 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
32 |
$3K |
| D0330 |
Panoramic radiographic image |
117 |
117 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
37 |
37 |
$1K |
| D1351 |
Sealant - per tooth |
39 |
12 |
$409.41 |
| D1330 |
|
69 |
69 |
$82.21 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
32 |
$0.00 |