| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,739 |
12,702 |
$719K |
| D1120 |
Prophylaxis - child |
12,195 |
12,162 |
$482K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63,492 |
13,191 |
$339K |
| D1351 |
Sealant - per tooth |
8,472 |
1,982 |
$243K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,158 |
2,303 |
$209K |
| D1110 |
Prophylaxis - adult |
2,441 |
2,430 |
$202K |
| D0272 |
Bitewings - two radiographic images |
11,487 |
11,455 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,823 |
11,776 |
$134K |
| D1310 |
|
2,790 |
2,771 |
$127K |
| D2140 |
|
2,207 |
1,761 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,759 |
$108K |
| D9993 |
|
1,339 |
1,335 |
$83K |
| D1206 |
Topical application of fluoride varnish |
2,825 |
2,812 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
904 |
505 |
$51K |
| D2160 |
|
497 |
427 |
$39K |
| D0603 |
|
2,033 |
2,021 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,243 |
2,227 |
$26K |
| D2330 |
|
248 |
164 |
$19K |
| D9430 |
|
483 |
476 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
219 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
156 |
155 |
$8K |
| D0602 |
|
402 |
400 |
$6K |
| D4341 |
|
35 |
14 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D0601 |
|
28 |
27 |
$401.00 |