| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,425 |
1,423 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
852 |
$68K |
| D1120 |
Prophylaxis - child |
1,306 |
1,304 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,269 |
1,798 |
$42K |
| D1351 |
Sealant - per tooth |
1,168 |
272 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
437 |
215 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
498 |
498 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,702 |
1,700 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,704 |
1,701 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,125 |
1,033 |
$13K |
| D1110 |
Prophylaxis - adult |
119 |
118 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
41 |
$5K |
| D9430 |
|
120 |
118 |
$4K |
| D2160 |
|
48 |
27 |
$4K |
| D0350 |
|
221 |
183 |
$3K |
| D2140 |
|
30 |
16 |
$2K |