| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,835 |
7,775 |
$408K |
| D1120 |
Prophylaxis - child |
7,300 |
7,250 |
$262K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,407 |
9,626 |
$210K |
| D1351 |
Sealant - per tooth |
7,253 |
2,277 |
$185K |
| D2140 |
|
2,692 |
1,638 |
$145K |
| D0274 |
Bitewings - four radiographic images |
8,092 |
8,038 |
$142K |
| D1110 |
Prophylaxis - adult |
1,382 |
1,369 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,582 |
1,078 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,148 |
6,108 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
887 |
886 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,532 |
3,739 |
$53K |
| D0350 |
|
5,044 |
2,510 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
734 |
496 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,627 |
2,607 |
$37K |
| D4341 |
|
212 |
57 |
$13K |
| D4910 |
|
42 |
42 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$2K |
| D2160 |
|
12 |
12 |
$957.60 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |