| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,582 |
1,565 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,298 |
1,283 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,258 |
1,304 |
$25K |
| D1351 |
Sealant - per tooth |
1,010 |
243 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,576 |
1,558 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
326 |
$17K |
| D0272 |
Bitewings - two radiographic images |
959 |
950 |
$10K |
| D9993 |
|
146 |
144 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
68 |
$7K |
| D1310 |
|
147 |
145 |
$6K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
25 |
$2K |
| D2160 |
|
22 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$677.00 |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
66 |
$658.00 |
| D0601 |
|
42 |
42 |
$630.00 |
| D0350 |
|
16 |
13 |
$90.00 |
| D1330 |
|
420 |
412 |
$0.00 |