| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,910 |
7,012 |
$184K |
| D1110 |
Prophylaxis - adult |
4,540 |
4,030 |
$155K |
| D1120 |
Prophylaxis - child |
4,883 |
4,401 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,445 |
6,667 |
$114K |
| D0330 |
Panoramic radiographic image |
1,500 |
1,364 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,409 |
2,164 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
667 |
514 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,423 |
1,307 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,560 |
2,346 |
$45K |
| D1351 |
Sealant - per tooth |
1,612 |
410 |
$43K |
| D2140 |
|
385 |
295 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
736 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
84 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
14 |
$433.46 |