| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,629 |
2,612 |
$139K |
| D1120 |
Prophylaxis - child |
2,478 |
2,450 |
$89K |
| D9430 |
|
1,472 |
1,322 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
759 |
756 |
$45K |
| D1110 |
Prophylaxis - adult |
371 |
371 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,308 |
1,379 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,083 |
2,065 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
482 |
478 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
210 |
105 |
$14K |
| D0272 |
Bitewings - two radiographic images |
945 |
939 |
$11K |
| D1206 |
Topical application of fluoride varnish |
562 |
558 |
$8K |
| D1351 |
Sealant - per tooth |
281 |
90 |
$6K |
| D2140 |
|
45 |
25 |
$2K |
| D1310 |
|
77 |
77 |
$2K |
| D9993 |
|
45 |
45 |
$2K |
| D0350 |
|
83 |
38 |
$873.60 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$308.00 |
| D0602 |
|
15 |
15 |
$0.00 |