| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,830 |
5,806 |
$409K |
| D1351 |
Sealant - per tooth |
6,131 |
1,587 |
$209K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,568 |
808 |
$110K |
| D1120 |
Prophylaxis - child |
5,796 |
5,776 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
4,763 |
4,706 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
561 |
$56K |
| D2140 |
|
638 |
414 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
387 |
221 |
$26K |
| D1206 |
Topical application of fluoride varnish |
6,124 |
6,099 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
185 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,367 |
4,244 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,673 |
2,665 |
$5K |
| D1110 |
Prophylaxis - adult |
334 |
330 |
$2K |
| D0330 |
Panoramic radiographic image |
186 |
186 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,126 |
1,117 |
$712.10 |
| D9248 |
|
39 |
37 |
$671.24 |