| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,429 |
2,407 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,153 |
2,068 |
$51K |
| D1110 |
Prophylaxis - adult |
1,406 |
1,392 |
$50K |
| D1120 |
Prophylaxis - child |
1,451 |
1,437 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
144 |
$17K |
| D1999 |
|
1,647 |
1,492 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
201 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
412 |
$10K |
| D2140 |
|
187 |
111 |
$10K |
| D0274 |
Bitewings - four radiographic images |
399 |
394 |
$8K |
| D0272 |
Bitewings - two radiographic images |
335 |
335 |
$5K |
| D0240 |
|
521 |
277 |
$4K |
| D1351 |
Sealant - per tooth |
65 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$171.36 |