| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,660 |
2,639 |
$176K |
| D1120 |
Prophylaxis - child |
2,603 |
2,590 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
1,684 |
1,683 |
$132K |
| D1110 |
Prophylaxis - adult |
1,423 |
1,413 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,218 |
4,192 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,127 |
1,119 |
$54K |
| D1351 |
Sealant - per tooth |
1,279 |
312 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,137 |
2,874 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,437 |
1,428 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
397 |
225 |
$27K |
| D1310 |
|
328 |
326 |
$15K |
| D9430 |
|
405 |
397 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,056 |
1,025 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
24 |
$4K |
| D2140 |
|
74 |
43 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
24 |
$4K |
| D0350 |
|
133 |
130 |
$2K |
| D0272 |
Bitewings - two radiographic images |
177 |
177 |
$2K |
| D0602 |
|
118 |
118 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0603 |
|
14 |
14 |
$165.00 |
| D9993 |
|
155 |
155 |
$0.00 |