| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,852 |
3,833 |
$198K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,219 |
1,302 |
$147K |
| D1120 |
Prophylaxis - child |
3,399 |
3,385 |
$122K |
| D2140 |
|
2,014 |
1,076 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,728 |
5,296 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,265 |
3,250 |
$68K |
| D1110 |
Prophylaxis - adult |
810 |
808 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,571 |
4,551 |
$54K |
| D0350 |
|
4,719 |
2,074 |
$46K |
| D1351 |
Sealant - per tooth |
1,688 |
467 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,183 |
2,020 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
374 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
303 |
195 |
$17K |
| D2160 |
|
183 |
142 |
$14K |
| D4910 |
|
135 |
132 |
$10K |
| D9430 |
|
288 |
280 |
$9K |
| D0272 |
Bitewings - two radiographic images |
389 |
386 |
$4K |
| D2330 |
|
16 |
12 |
$1K |