| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,730 |
7,706 |
$424K |
| D1120 |
Prophylaxis - child |
10,264 |
10,227 |
$392K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,064 |
2,060 |
$128K |
| D1351 |
Sealant - per tooth |
4,758 |
991 |
$123K |
| D0274 |
Bitewings - four radiographic images |
5,711 |
5,694 |
$121K |
| D1310 |
|
2,158 |
2,153 |
$99K |
| D1206 |
Topical application of fluoride varnish |
5,756 |
5,730 |
$97K |
| D9993 |
|
1,095 |
1,095 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,725 |
8,380 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,614 |
4,602 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,516 |
2,507 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
357 |
184 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
370 |
370 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
118 |
$9K |
| D0603 |
|
565 |
565 |
$8K |
| D0602 |
|
397 |
397 |
$6K |
| D0601 |
|
337 |
332 |
$5K |
| D1110 |
Prophylaxis - adult |
43 |
43 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
14 |
$2K |