| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,328 |
2,209 |
$730K |
| D0120 |
Periodic oral evaluation - established patient |
1,796 |
1,787 |
$260K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,097 |
1,096 |
$215K |
| D7140 |
Extraction, erupted tooth or exposed root |
650 |
438 |
$121K |
| D1120 |
Prophylaxis - child |
1,594 |
1,592 |
$60K |
| D1351 |
Sealant - per tooth |
3,018 |
610 |
$54K |
| D1206 |
Topical application of fluoride varnish |
3,150 |
3,035 |
$50K |
| D1110 |
Prophylaxis - adult |
670 |
668 |
$47K |
| D1354 |
|
2,746 |
545 |
$42K |
| D0330 |
Panoramic radiographic image |
832 |
830 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,432 |
2,355 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
395 |
$16K |
| D0274 |
Bitewings - four radiographic images |
816 |
814 |
$10K |
| D0272 |
Bitewings - two radiographic images |
574 |
573 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
15 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
227 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$385.50 |
| D1353 |
|
37 |
12 |
$0.00 |
| D1355 |
|
36 |
13 |
$0.00 |