| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,042 |
14,031 |
$771K |
| D1120 |
Prophylaxis - child |
13,950 |
13,942 |
$540K |
| D0274 |
Bitewings - four radiographic images |
9,818 |
9,812 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,838 |
15,387 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,616 |
10,605 |
$110K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,002 |
773 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,207 |
4,139 |
$49K |
| D1110 |
Prophylaxis - adult |
444 |
444 |
$37K |
| D1310 |
|
656 |
656 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,260 |
2,260 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
448 |
311 |
$25K |
| D9430 |
|
764 |
732 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
427 |
$24K |
| D1206 |
Topical application of fluoride varnish |
423 |
419 |
$13K |
| D0601 |
|
493 |
493 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
96 |
$4K |
| D2160 |
|
42 |
38 |
$3K |
| D2954 |
|
28 |
25 |
$3K |