| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,707 |
2,698 |
$142K |
| D1120 |
Prophylaxis - child |
3,162 |
3,149 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,285 |
1,275 |
$82K |
| D2330 |
|
973 |
449 |
$74K |
| D1351 |
Sealant - per tooth |
1,909 |
648 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,042 |
1,035 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,521 |
3,502 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,356 |
2,988 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,386 |
1,378 |
$29K |
| D1310 |
|
248 |
244 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
165 |
81 |
$11K |
| D0272 |
Bitewings - two radiographic images |
848 |
845 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
55 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
452 |
441 |
$5K |
| D0603 |
|
240 |
235 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
26 |
$3K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |