| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,440 |
10,324 |
$969K |
| D1351 |
Sealant - per tooth |
5,732 |
986 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,507 |
855 |
$138K |
| D1120 |
Prophylaxis - child |
9,691 |
9,565 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
858 |
842 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
831 |
521 |
$62K |
| D0272 |
Bitewings - two radiographic images |
8,186 |
8,066 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,941 |
1,051 |
$55K |
| D1206 |
Topical application of fluoride varnish |
11,387 |
11,256 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
573 |
291 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,778 |
1,763 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
251 |
85 |
$22K |
| D2140 |
|
1,139 |
708 |
$21K |
| D0330 |
Panoramic radiographic image |
933 |
920 |
$18K |
| D1110 |
Prophylaxis - adult |
732 |
718 |
$17K |
| D9420 |
|
84 |
83 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,237 |
1,170 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
116 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
442 |
370 |
$2K |
| D2330 |
|
19 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
188 |
$175.57 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |