| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,493 |
3,478 |
$467K |
| D1351 |
Sealant - per tooth |
5,530 |
1,032 |
$153K |
| D2140 |
|
1,272 |
706 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,217 |
726 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
164 |
163 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,416 |
2,395 |
$20K |
| D1120 |
Prophylaxis - child |
3,264 |
3,246 |
$12K |
| D1206 |
Topical application of fluoride varnish |
3,004 |
2,997 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
63 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,820 |
1,803 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,151 |
2,099 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
145 |
$3K |
| D1110 |
Prophylaxis - adult |
109 |
108 |
$1K |
| D0330 |
Panoramic radiographic image |
52 |
52 |
$63.26 |
| D0274 |
Bitewings - four radiographic images |
488 |
486 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |