| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,393 |
2,349 |
$215K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
513 |
274 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,126 |
2,085 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
226 |
$23K |
| D1120 |
Prophylaxis - child |
2,557 |
2,512 |
$21K |
| D1351 |
Sealant - per tooth |
366 |
87 |
$14K |
| D1206 |
Topical application of fluoride varnish |
2,629 |
2,589 |
$11K |
| D2140 |
|
107 |
78 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,030 |
1,013 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
664 |
$2K |
| D0330 |
Panoramic radiographic image |
92 |
92 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$884.42 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$831.20 |
| D1110 |
Prophylaxis - adult |
118 |
116 |
$38.80 |
| D0274 |
Bitewings - four radiographic images |
65 |
64 |
$35.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
84 |
$0.00 |