| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,933 |
4,460 |
$345K |
| D1120 |
Prophylaxis - child |
3,145 |
3,113 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,185 |
1,177 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,263 |
1,241 |
$23K |
| D1110 |
Prophylaxis - adult |
816 |
813 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,675 |
1,666 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,413 |
1,391 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,757 |
2,704 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
263 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
108 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
326 |
322 |
$7K |
| D0274 |
Bitewings - four radiographic images |
525 |
520 |
$7K |
| D0601 |
|
737 |
737 |
$6K |
| D0602 |
|
738 |
724 |
$5K |
| D1351 |
Sealant - per tooth |
206 |
62 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
201 |
198 |
$4K |
| D2140 |
|
39 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
30 |
29 |
$377.00 |
| D0603 |
|
13 |
12 |
$100.00 |
| D1330 |
|
2,156 |
2,103 |
$0.00 |
| D1310 |
|
177 |
171 |
$0.00 |
| D1999 |
|
58 |
43 |
$0.00 |