| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,084 |
4,081 |
$219K |
| D1110 |
Prophylaxis - adult |
2,082 |
2,079 |
$175K |
| D1120 |
Prophylaxis - child |
3,529 |
3,529 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,753 |
$109K |
| D1351 |
Sealant - per tooth |
2,868 |
669 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,655 |
5,586 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,767 |
5,762 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,593 |
4,592 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
731 |
500 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
608 |
360 |
$35K |
| D2330 |
|
153 |
93 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
64 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
75 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
69 |
$6K |
| D0274 |
Bitewings - four radiographic images |
241 |
241 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
291 |
286 |
$3K |
| D9430 |
|
82 |
80 |
$3K |
| D9993 |
|
57 |
57 |
$2K |
| D1310 |
|
65 |
64 |
$2K |
| D9110 |
|
27 |
27 |
$2K |
| D2160 |
|
16 |
15 |
$1K |
| D0603 |
|
63 |
62 |
$600.00 |