| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,503 |
2,484 |
$122K |
| D1120 |
Prophylaxis - child |
2,173 |
2,148 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,118 |
2,485 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,187 |
2,178 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,472 |
2,456 |
$24K |
| D1351 |
Sealant - per tooth |
1,168 |
325 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
165 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
39 |
$2K |
| D4910 |
|
17 |
17 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$975.80 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
51 |
$580.00 |