| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,319 |
7,932 |
$337K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,291 |
7,908 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
6,925 |
6,608 |
$192K |
| D1351 |
Sealant - per tooth |
1,900 |
996 |
$150K |
| D0274 |
Bitewings - four radiographic images |
3,117 |
2,977 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,877 |
1,777 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
4,436 |
4,229 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,115 |
3,925 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
161 |
106 |
$11K |
| D1110 |
Prophylaxis - adult |
158 |
152 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
21 |
21 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
298 |
267 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
159 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
167 |
$1K |
| D0190 |
|
80 |
75 |
$0.00 |
| D1999 |
|
82 |
75 |
$0.00 |