| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,939 |
13,878 |
$757K |
| D1120 |
Prophylaxis - child |
14,713 |
14,649 |
$561K |
| D1351 |
Sealant - per tooth |
12,481 |
2,761 |
$349K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,964 |
2,033 |
$198K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,648 |
14,585 |
$170K |
| D0272 |
Bitewings - two radiographic images |
11,965 |
11,912 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
2,299 |
2,295 |
$106K |
| D2140 |
|
1,381 |
1,026 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,680 |
8,175 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
779 |
484 |
$44K |
| D2330 |
|
446 |
234 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
155 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
167 |
167 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
419 |
414 |
$5K |
| D9430 |
|
135 |
134 |
$4K |
| D2160 |
|
16 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
53 |
53 |
$454.00 |
| D1201 |
|
52 |
52 |
$0.00 |