| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,652 |
3,460 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
3,868 |
3,639 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,578 |
3,382 |
$90K |
| D1351 |
Sealant - per tooth |
384 |
210 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,185 |
3,917 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,315 |
1,223 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,906 |
3,622 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,439 |
1,357 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
291 |
$6K |
| D1110 |
Prophylaxis - adult |
184 |
159 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
88 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$1K |
| D0270 |
|
189 |
174 |
$1K |
| D1999 |
|
150 |
129 |
$0.00 |