| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,165 |
5,162 |
$283K |
| D1110 |
Prophylaxis - adult |
2,217 |
2,213 |
$191K |
| D1120 |
Prophylaxis - child |
4,898 |
4,893 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,967 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,155 |
7,144 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
7,715 |
7,276 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,589 |
5,928 |
$54K |
| D1351 |
Sealant - per tooth |
763 |
149 |
$17K |
| D2140 |
|
201 |
124 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
79 |
$8K |
| D9430 |
|
199 |
193 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$1K |