| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,741 |
2,672 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
686 |
665 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
831 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
626 |
195 |
$35K |
| D1120 |
Prophylaxis - child |
2,598 |
2,539 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
420 |
244 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,354 |
1,331 |
$23K |
| D2140 |
|
419 |
242 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,682 |
1,624 |
$18K |
| D1351 |
Sealant - per tooth |
605 |
85 |
$17K |
| D1110 |
Prophylaxis - adult |
542 |
522 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
599 |
$10K |
| D1206 |
Topical application of fluoride varnish |
2,383 |
2,313 |
$10K |
| D0330 |
Panoramic radiographic image |
53 |
51 |
$62.74 |