| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,414 |
3,400 |
$214K |
| D1120 |
Prophylaxis - child |
4,034 |
4,017 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,291 |
2,277 |
$147K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,152 |
876 |
$144K |
| D1110 |
Prophylaxis - adult |
1,515 |
1,505 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
2,185 |
2,172 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,799 |
3,610 |
$84K |
| D1351 |
Sealant - per tooth |
2,523 |
433 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,682 |
5,654 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,216 |
3,202 |
$68K |
| D2140 |
|
692 |
316 |
$37K |
| D0350 |
|
1,436 |
1,063 |
$34K |
| D2160 |
|
187 |
122 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$120.00 |
| D1330 |
|
13 |
13 |
$0.00 |
| D0190 |
|
53 |
53 |
$0.00 |