| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,749 |
2,731 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,623 |
969 |
$108K |
| D1120 |
Prophylaxis - child |
2,430 |
2,425 |
$92K |
| D1110 |
Prophylaxis - adult |
961 |
960 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
818 |
815 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,185 |
3,177 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
681 |
365 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,492 |
3,569 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
67 |
48 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,654 |
2,649 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
615 |
613 |
$29K |
| D1351 |
Sealant - per tooth |
353 |
94 |
$8K |
| D4341 |
|
80 |
26 |
$6K |
| D1206 |
Topical application of fluoride varnish |
279 |
279 |
$4K |
| D4910 |
|
42 |
42 |
$3K |
| D9430 |
|
74 |
71 |
$2K |
| D2160 |
|
14 |
12 |
$1K |