| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,720 |
2,701 |
$149K |
| D1110 |
Prophylaxis - adult |
1,280 |
1,271 |
$109K |
| D1120 |
Prophylaxis - child |
2,220 |
2,197 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,164 |
1,155 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,138 |
3,177 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,301 |
3,279 |
$39K |
| D0330 |
Panoramic radiographic image |
1,239 |
1,237 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
738 |
733 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,136 |
2,133 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
223 |
116 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
953 |
921 |
$11K |
| D1351 |
Sealant - per tooth |
365 |
87 |
$9K |
| D0350 |
|
582 |
274 |
$5K |
| D9430 |
|
152 |
147 |
$5K |
| D2160 |
|
44 |
24 |
$4K |
| D4910 |
|
25 |
25 |
$2K |
| D2140 |
|
17 |
12 |
$928.20 |
| D1310 |
|
18 |
18 |
$0.00 |
| D1999 |
|
18 |
18 |
$0.00 |