| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,702 |
9,660 |
$526K |
| D1120 |
Prophylaxis - child |
8,081 |
8,051 |
$301K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,643 |
11,558 |
$299K |
| D1110 |
Prophylaxis - adult |
2,395 |
2,381 |
$206K |
| D0272 |
Bitewings - two radiographic images |
11,239 |
11,189 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,023 |
2,018 |
$126K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,728 |
1,255 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,065 |
8,035 |
$83K |
| D9430 |
|
1,480 |
1,438 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
530 |
380 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,618 |
1,605 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,123 |
2,024 |
$25K |
| D1351 |
Sealant - per tooth |
858 |
214 |
$19K |
| D2330 |
|
71 |
44 |
$5K |
| D2160 |
|
58 |
38 |
$5K |
| D2140 |
|
74 |
56 |
$4K |