| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,427 |
4,389 |
$410K |
| D1351 |
Sealant - per tooth |
3,136 |
772 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
3,527 |
3,497 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
633 |
357 |
$53K |
| D1120 |
Prophylaxis - child |
4,158 |
4,114 |
$29K |
| D2140 |
|
281 |
196 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
135 |
$12K |
| D1206 |
Topical application of fluoride varnish |
4,562 |
4,516 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,972 |
3,157 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,243 |
2,219 |
$5K |
| D1110 |
Prophylaxis - adult |
240 |
237 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
639 |
632 |
$2K |
| D9248 |
|
38 |
37 |
$984.68 |
| D0330 |
Panoramic radiographic image |
320 |
317 |
$561.32 |
| D0240 |
|
25 |
13 |
$38.00 |