| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,132 |
13,090 |
$557K |
| D0120 |
Periodic oral evaluation - established patient |
8,141 |
8,109 |
$513K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,881 |
2,881 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,064 |
13,023 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,408 |
9,290 |
$167K |
| D1351 |
Sealant - per tooth |
3,903 |
881 |
$123K |
| D1310 |
|
2,561 |
2,558 |
$110K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,584 |
1,580 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
5,021 |
5,001 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
634 |
340 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,628 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,340 |
2,325 |
$28K |
| D0601 |
|
1,158 |
1,158 |
$16K |
| D0603 |
|
873 |
873 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
75 |
$8K |
| D2140 |
|
91 |
57 |
$5K |
| D0602 |
|
294 |
294 |
$4K |
| D0350 |
|
251 |
149 |
$3K |
| D9430 |
|
43 |
43 |
$1K |
| D1203 |
|
12 |
12 |
$0.00 |