| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,148 |
4,126 |
$215K |
| D1351 |
Sealant - per tooth |
6,792 |
1,836 |
$173K |
| D1120 |
Prophylaxis - child |
4,766 |
4,738 |
$172K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,983 |
1,151 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,246 |
4,723 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,114 |
1,113 |
$65K |
| D0272 |
Bitewings - two radiographic images |
4,378 |
4,357 |
$51K |
| D2140 |
|
897 |
548 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,054 |
4,026 |
$40K |
| D1110 |
Prophylaxis - adult |
402 |
397 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
677 |
673 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
191 |
$16K |
| D1206 |
Topical application of fluoride varnish |
304 |
302 |
$5K |
| D2160 |
|
50 |
37 |
$4K |
| D2332 |
|
44 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
51 |
$582.00 |
| D1310 |
|
206 |
206 |
$0.00 |
| D1330 |
|
123 |
123 |
$0.00 |