| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,354 |
3,336 |
$224K |
| D1120 |
Prophylaxis - child |
3,302 |
3,291 |
$133K |
| D1110 |
Prophylaxis - adult |
1,138 |
1,130 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,191 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,121 |
817 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,328 |
3,309 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,339 |
4,184 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,523 |
4,504 |
$54K |
| D1351 |
Sealant - per tooth |
1,918 |
563 |
$53K |
| D0350 |
|
1,581 |
1,411 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
505 |
$24K |
| D9430 |
|
256 |
254 |
$8K |
| D2160 |
|
89 |
67 |
$7K |
| D2140 |
|
110 |
91 |
$6K |
| D0272 |
Bitewings - two radiographic images |
122 |
121 |
$1K |
| D2330 |
|
18 |
13 |
$1K |
| D0270 |
|
42 |
41 |
$205.00 |