| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,838 |
4,799 |
$262K |
| D1110 |
Prophylaxis - adult |
2,647 |
2,630 |
$218K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,306 |
1,285 |
$150K |
| D1120 |
Prophylaxis - child |
3,762 |
3,738 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,371 |
4,848 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,578 |
1,578 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
2,044 |
2,044 |
$93K |
| D1351 |
Sealant - per tooth |
2,893 |
731 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,894 |
5,856 |
$69K |
| D2140 |
|
1,117 |
633 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,017 |
555 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,698 |
2,676 |
$56K |
| D2160 |
|
428 |
281 |
$33K |
| D0350 |
|
2,818 |
1,246 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
1,216 |
$14K |
| D0272 |
Bitewings - two radiographic images |
875 |
875 |
$10K |
| D9430 |
|
304 |
292 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
36 |
$5K |
| D9993 |
|
69 |
69 |
$4K |
| D1310 |
|
69 |
69 |
$3K |
| D2330 |
|
21 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$1K |