| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,993 |
7,968 |
$449K |
| D1110 |
Prophylaxis - adult |
3,957 |
3,940 |
$341K |
| D1120 |
Prophylaxis - child |
6,570 |
6,543 |
$250K |
| D1351 |
Sealant - per tooth |
7,218 |
1,462 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,382 |
2,376 |
$149K |
| D0274 |
Bitewings - four radiographic images |
6,172 |
6,151 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,031 |
1,123 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,818 |
7,926 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,505 |
5,487 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
768 |
402 |
$42K |
| D4341 |
|
493 |
129 |
$34K |
| D2140 |
|
473 |
287 |
$25K |
| D2330 |
|
285 |
151 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
195 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,368 |
1,327 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
54 |
$9K |
| D0272 |
Bitewings - two radiographic images |
396 |
393 |
$5K |
| D1330 |
|
120 |
120 |
$0.00 |