| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,885 |
4,866 |
$291K |
| D1120 |
Prophylaxis - child |
5,030 |
5,011 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,713 |
1,712 |
$109K |
| D1110 |
Prophylaxis - adult |
1,116 |
1,115 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,531 |
6,504 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,557 |
1,555 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,234 |
3,223 |
$66K |
| D1351 |
Sealant - per tooth |
2,651 |
729 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,664 |
5,239 |
$55K |
| D9430 |
|
925 |
900 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,546 |
1,527 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
63 |
$6K |
| D9993 |
|
76 |
76 |
$5K |
| D1310 |
|
90 |
90 |
$4K |
| D0272 |
Bitewings - two radiographic images |
290 |
290 |
$3K |
| D2140 |
|
17 |
14 |
$928.20 |