| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,320 |
5,317 |
$206K |
| D1120 |
Prophylaxis - child |
5,721 |
5,710 |
$170K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,244 |
812 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,873 |
3,872 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,632 |
5,618 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,145 |
5,598 |
$42K |
| D1351 |
Sealant - per tooth |
1,844 |
574 |
$39K |
| D2140 |
|
574 |
441 |
$30K |
| D2160 |
|
235 |
190 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,494 |
1,493 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
138 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
65 |
$5K |
| D0330 |
Panoramic radiographic image |
138 |
138 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
217 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
14 |
$392.00 |