| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,505 |
2,485 |
$135K |
| D1120 |
Prophylaxis - child |
2,146 |
2,129 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,047 |
2,059 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
561 |
$34K |
| D1110 |
Prophylaxis - adult |
265 |
265 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,203 |
2,187 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,108 |
1,098 |
$13K |
| D9430 |
|
392 |
377 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
570 |
559 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
95 |
$4K |
| D0274 |
Bitewings - four radiographic images |
142 |
142 |
$3K |
| D0350 |
|
205 |
108 |
$2K |
| D1351 |
Sealant - per tooth |
70 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |