| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,280 |
3,148 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,158 |
3,986 |
$116K |
| D1351 |
Sealant - per tooth |
1,017 |
558 |
$68K |
| D1206 |
Topical application of fluoride varnish |
1,718 |
1,608 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,321 |
2,213 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,515 |
1,502 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
481 |
353 |
$34K |
| D4342 |
|
183 |
79 |
$26K |
| D9110 |
|
366 |
342 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,841 |
2,701 |
$17K |
| D1110 |
Prophylaxis - adult |
417 |
405 |
$15K |
| D4341 |
|
47 |
33 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,687 |
2,543 |
$12K |
| D4910 |
|
108 |
101 |
$7K |
| D2160 |
|
79 |
60 |
$5K |
| D0272 |
Bitewings - two radiographic images |
487 |
460 |
$5K |
| D1354 |
|
47 |
26 |
$1K |
| D2331 |
|
18 |
15 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
45 |
$968.30 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$625.92 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$615.60 |
| D1999 |
|
26 |
24 |
$0.00 |