| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,043 |
6,025 |
$329K |
| D1120 |
Prophylaxis - child |
6,173 |
6,154 |
$237K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,400 |
2,393 |
$153K |
| D1110 |
Prophylaxis - adult |
1,688 |
1,681 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,830 |
8,699 |
$106K |
| D0272 |
Bitewings - two radiographic images |
7,955 |
7,933 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,747 |
7,726 |
$91K |
| D2140 |
|
758 |
551 |
$41K |
| D1351 |
Sealant - per tooth |
935 |
271 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
162 |
118 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
641 |
638 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
53 |
$5K |
| D9430 |
|
83 |
83 |
$3K |