| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,216 |
5,211 |
$278K |
| D1120 |
Prophylaxis - child |
5,130 |
5,122 |
$188K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,575 |
7,200 |
$161K |
| D1351 |
Sealant - per tooth |
5,106 |
1,755 |
$138K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,942 |
1,046 |
$127K |
| D1110 |
Prophylaxis - adult |
1,431 |
1,429 |
$120K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,925 |
987 |
$108K |
| D2140 |
|
1,968 |
993 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,506 |
4,501 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,375 |
1,371 |
$85K |
| D1206 |
Topical application of fluoride varnish |
5,008 |
5,002 |
$67K |
| D0350 |
|
4,335 |
2,094 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,996 |
1,872 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,603 |
1,598 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,639 |
1,635 |
$17K |
| D4341 |
|
185 |
48 |
$13K |
| D2160 |
|
51 |
30 |
$4K |