| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,412 |
3,399 |
$208K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,549 |
1,196 |
$170K |
| D1120 |
Prophylaxis - child |
4,005 |
3,957 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,427 |
2,420 |
$149K |
| D1110 |
Prophylaxis - adult |
1,709 |
1,700 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,584 |
5,492 |
$100K |
| D1351 |
Sealant - per tooth |
3,183 |
774 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,649 |
3,614 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,805 |
5,748 |
$75K |
| D2140 |
|
1,034 |
534 |
$56K |
| D4341 |
|
571 |
153 |
$40K |
| D0350 |
|
3,947 |
1,491 |
$37K |
| D4910 |
|
441 |
437 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
495 |
494 |
$23K |
| D0272 |
Bitewings - two radiographic images |
778 |
764 |
$9K |
| D2160 |
|
105 |
77 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
93 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
525 |
518 |
$6K |
| D9430 |
|
140 |
140 |
$4K |
| D0270 |
|
13 |
13 |
$65.00 |