| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,029 |
4,023 |
$228K |
| D1120 |
Prophylaxis - child |
5,372 |
5,363 |
$211K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,933 |
1,294 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,529 |
1,526 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,070 |
5,442 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,988 |
5,976 |
$83K |
| D2140 |
|
1,481 |
985 |
$80K |
| D1351 |
Sealant - per tooth |
1,708 |
472 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,654 |
3,637 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,990 |
1,988 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
29 |
$2K |