| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,692 |
1,684 |
$86K |
| D1120 |
Prophylaxis - child |
1,962 |
1,950 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,499 |
2,556 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
802 |
362 |
$45K |
| D2140 |
|
589 |
142 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,433 |
2,420 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
304 |
300 |
$17K |
| D1351 |
Sealant - per tooth |
787 |
195 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,079 |
1,001 |
$12K |
| D0274 |
Bitewings - four radiographic images |
571 |
568 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
164 |
69 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
169 |
64 |
$9K |
| D0350 |
|
1,187 |
294 |
$9K |
| D0272 |
Bitewings - two radiographic images |
400 |
396 |
$4K |
| D1110 |
Prophylaxis - adult |
58 |
57 |
$4K |
| D9430 |
|
41 |
41 |
$1K |