| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,553 |
4,535 |
$242K |
| D2140 |
|
4,138 |
1,373 |
$224K |
| D1120 |
Prophylaxis - child |
4,616 |
4,596 |
$174K |
| D1110 |
Prophylaxis - adult |
1,049 |
1,042 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,293 |
1,287 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,670 |
5,637 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
940 |
575 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,313 |
2,301 |
$49K |
| D1351 |
Sealant - per tooth |
1,526 |
367 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,636 |
3,584 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
590 |
336 |
$34K |
| D9993 |
|
401 |
398 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,056 |
2,045 |
$24K |
| D1310 |
|
493 |
490 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,497 |
1,488 |
$18K |
| D0350 |
|
636 |
296 |
$7K |
| D0602 |
|
239 |
236 |
$4K |
| D9430 |
|
108 |
105 |
$3K |