| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,229 |
1,227 |
$60K |
| D1120 |
Prophylaxis - child |
1,359 |
1,353 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,315 |
1,929 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
203 |
$26K |
| D2140 |
|
399 |
90 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,797 |
1,789 |
$20K |
| D1351 |
Sealant - per tooth |
440 |
98 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
128 |
58 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
593 |
557 |
$7K |
| D0274 |
Bitewings - four radiographic images |
265 |
265 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
82 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
25 |
$4K |
| D0350 |
|
459 |
107 |
$4K |
| D0272 |
Bitewings - two radiographic images |
286 |
285 |
$3K |