| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,846 |
3,832 |
$179K |
| D1120 |
Prophylaxis - child |
3,905 |
3,883 |
$128K |
| D1351 |
Sealant - per tooth |
3,904 |
771 |
$95K |
| D1110 |
Prophylaxis - adult |
898 |
894 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,119 |
1,117 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,489 |
2,479 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
747 |
516 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,618 |
4,577 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,874 |
4,117 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
965 |
960 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,181 |
2,147 |
$25K |
| D9430 |
|
400 |
400 |
$13K |
| D9993 |
|
121 |
121 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
62 |
$5K |
| D1310 |
|
121 |
121 |
$5K |
| D2160 |
|
17 |
14 |
$1K |
| D0601 |
|
43 |
43 |
$645.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$140.00 |