| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,951 |
3,938 |
$161K |
| D1120 |
Prophylaxis - child |
3,959 |
3,943 |
$117K |
| D1110 |
Prophylaxis - adult |
1,383 |
1,380 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,604 |
1,603 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,874 |
5,859 |
$66K |
| D1351 |
Sealant - per tooth |
2,621 |
665 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
718 |
439 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,015 |
2,958 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
744 |
741 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,577 |
1,574 |
$32K |
| D9993 |
|
349 |
348 |
$22K |
| D1310 |
|
349 |
348 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,007 |
988 |
$12K |
| D0272 |
Bitewings - two radiographic images |
417 |
416 |
$5K |
| D9430 |
|
145 |
139 |
$5K |
| D0350 |
|
427 |
287 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
41 |
$3K |
| D2140 |
|
36 |
25 |
$2K |
| D0603 |
|
62 |
62 |
$915.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D0602 |
|
12 |
12 |
$180.00 |