| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,681 |
3,671 |
$187K |
| D1120 |
Prophylaxis - child |
4,116 |
4,104 |
$152K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,186 |
622 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,149 |
1,144 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,183 |
5,241 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,905 |
4,888 |
$53K |
| D0272 |
Bitewings - two radiographic images |
3,740 |
3,729 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
788 |
785 |
$37K |
| D1110 |
Prophylaxis - adult |
407 |
403 |
$34K |
| D1351 |
Sealant - per tooth |
1,141 |
231 |
$29K |
| D2160 |
|
198 |
131 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,113 |
1,823 |
$14K |
| D1320 |
|
1,001 |
998 |
$14K |
| D1310 |
|
239 |
238 |
$11K |
| D9993 |
|
114 |
113 |
$7K |
| D9430 |
|
41 |
39 |
$1K |
| D0601 |
|
25 |
25 |
$375.00 |
| D0603 |
|
12 |
12 |
$180.00 |
| D0270 |
|
21 |
18 |
$100.00 |
| D0350 |
|
17 |
12 |
$90.00 |