| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,984 |
6,795 |
$201K |
| D1120 |
Prophylaxis - child |
4,595 |
4,460 |
$139K |
| D1206 |
Topical application of fluoride varnish |
7,442 |
7,218 |
$129K |
| D1110 |
Prophylaxis - adult |
2,544 |
2,477 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
2,027 |
1,908 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,556 |
1,231 |
$20K |
| D0274 |
Bitewings - four radiographic images |
566 |
556 |
$19K |
| D1351 |
Sealant - per tooth |
574 |
177 |
$19K |
| D0272 |
Bitewings - two radiographic images |
821 |
793 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
192 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
91 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
27 |
$3K |
| D2140 |
|
29 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$716.98 |
| D0240 |
|
21 |
12 |
$516.80 |