| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,901 |
7,884 |
$441K |
| D1120 |
Prophylaxis - child |
6,875 |
6,856 |
$262K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,148 |
7,390 |
$196K |
| D1110 |
Prophylaxis - adult |
2,033 |
2,025 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,287 |
9,265 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
1,362 |
1,360 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
922 |
346 |
$62K |
| D0272 |
Bitewings - two radiographic images |
4,163 |
4,157 |
$49K |
| D9430 |
|
1,398 |
1,332 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
669 |
370 |
$38K |
| D1351 |
Sealant - per tooth |
1,305 |
275 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
566 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,938 |
1,925 |
$23K |
| D0274 |
Bitewings - four radiographic images |
175 |
175 |
$3K |
| D2140 |
|
26 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$736.00 |
| D9994 |
|
102 |
102 |
$0.00 |