| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,461 |
8,415 |
$467K |
| D1120 |
Prophylaxis - child |
7,446 |
7,415 |
$281K |
| D1110 |
Prophylaxis - adult |
2,724 |
2,705 |
$234K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,470 |
2,036 |
$232K |
| D1351 |
Sealant - per tooth |
8,377 |
2,768 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,150 |
9,197 |
$214K |
| D0274 |
Bitewings - four radiographic images |
6,235 |
6,203 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,776 |
9,724 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,735 |
1,727 |
$109K |
| D2160 |
|
603 |
468 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
763 |
758 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
583 |
372 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,265 |
2,255 |
$27K |
| D2140 |
|
447 |
350 |
$24K |
| D1310 |
|
357 |
356 |
$16K |
| D9993 |
|
262 |
262 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
651 |
649 |
$8K |
| D4341 |
|
103 |
27 |
$5K |
| D9430 |
|
123 |
117 |
$4K |
| D0601 |
|
257 |
257 |
$4K |
| D2330 |
|
36 |
27 |
$3K |