| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,060 |
4,046 |
$221K |
| D1120 |
Prophylaxis - child |
3,938 |
3,928 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,896 |
1,238 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
835 |
592 |
$56K |
| D4910 |
|
542 |
538 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,201 |
4,598 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,630 |
3,623 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
579 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,927 |
2,919 |
$34K |
| D0274 |
Bitewings - four radiographic images |
995 |
995 |
$21K |
| D2140 |
|
200 |
143 |
$11K |
| D4341 |
|
146 |
40 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
179 |
179 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
57 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$1K |
| D9430 |
|
14 |
14 |
$448.00 |
| D1999 |
|
38 |
38 |
$0.00 |