| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,425 |
2,402 |
$128K |
| D1120 |
Prophylaxis - child |
1,935 |
1,912 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,120 |
2,927 |
$59K |
| D1110 |
Prophylaxis - adult |
600 |
599 |
$49K |
| D1351 |
Sealant - per tooth |
1,822 |
533 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
675 |
598 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,989 |
2,963 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,230 |
1,227 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,540 |
1,477 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
88 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
143 |
$7K |
| D9430 |
|
120 |
118 |
$4K |
| D0350 |
|
298 |
163 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
123 |
$1K |