| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,122 |
$185K |
| D1351 |
Sealant - per tooth |
4,897 |
1,122 |
$163K |
| D1120 |
Prophylaxis - child |
3,232 |
3,214 |
$140K |
| D1110 |
Prophylaxis - adult |
1,323 |
1,310 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,746 |
$112K |
| D2140 |
|
1,995 |
1,101 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,259 |
823 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,091 |
3,073 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,534 |
3,831 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,755 |
3,731 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
771 |
761 |
$36K |
| D0350 |
|
1,813 |
1,007 |
$17K |
| D2160 |
|
120 |
95 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
742 |
733 |
$9K |
| D9430 |
|
210 |
209 |
$7K |
| D0272 |
Bitewings - two radiographic images |
136 |
136 |
$2K |