| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,269 |
4,256 |
$233K |
| D1120 |
Prophylaxis - child |
3,190 |
3,170 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,267 |
5,244 |
$109K |
| D1110 |
Prophylaxis - adult |
1,265 |
1,260 |
$109K |
| D4341 |
|
1,072 |
282 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,784 |
2,772 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
817 |
815 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,499 |
2,484 |
$26K |
| D9430 |
|
532 |
529 |
$17K |
| D2140 |
|
261 |
134 |
$14K |
| D4910 |
|
165 |
165 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
128 |
75 |
$9K |
| D0272 |
Bitewings - two radiographic images |
569 |
568 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
524 |
520 |
$6K |
| D0350 |
|
369 |
207 |
$4K |
| D1351 |
Sealant - per tooth |
114 |
27 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
29 |
$2K |