| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,014 |
5,003 |
$261K |
| D1120 |
Prophylaxis - child |
4,716 |
4,706 |
$174K |
| D1110 |
Prophylaxis - adult |
1,340 |
1,330 |
$112K |
| D1351 |
Sealant - per tooth |
3,402 |
1,158 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,828 |
4,860 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,172 |
669 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,160 |
6,140 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,100 |
1,098 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,332 |
2,321 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
645 |
$39K |
| D2140 |
|
633 |
341 |
$34K |
| D1310 |
|
445 |
445 |
$19K |
| D4341 |
|
334 |
78 |
$18K |
| D0350 |
|
1,753 |
774 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,271 |
1,270 |
$15K |
| D9993 |
|
445 |
445 |
$14K |
| D2160 |
|
64 |
50 |
$5K |
| D1320 |
|
318 |
318 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$2K |
| D0603 |
|
126 |
126 |
$2K |
| D9430 |
|
12 |
12 |
$380.00 |
| D0602 |
|
17 |
17 |
$255.00 |