| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,239 |
3,239 |
$130K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,748 |
941 |
$117K |
| D1120 |
Prophylaxis - child |
2,956 |
2,955 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,569 |
4,194 |
$71K |
| D1351 |
Sealant - per tooth |
3,265 |
1,091 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,042 |
3,027 |
$63K |
| D1110 |
Prophylaxis - adult |
769 |
768 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
512 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
695 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,249 |
3,248 |
$32K |
| D2140 |
|
537 |
389 |
$29K |
| D2330 |
|
278 |
179 |
$21K |
| D0272 |
Bitewings - two radiographic images |
704 |
704 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
455 |
450 |
$5K |
| D2160 |
|
40 |
36 |
$3K |
| D9430 |
|
43 |
43 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |