| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,423 |
4,395 |
$221K |
| D1120 |
Prophylaxis - child |
4,153 |
4,128 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,072 |
2,063 |
$128K |
| D1110 |
Prophylaxis - adult |
880 |
871 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,728 |
4,975 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,531 |
1,525 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,155 |
3,130 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,253 |
5,213 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
729 |
404 |
$48K |
| D2140 |
|
653 |
351 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
25 |
$17K |
| D0350 |
|
1,810 |
757 |
$16K |
| D0272 |
Bitewings - two radiographic images |
860 |
858 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
60 |
$6K |
| D1351 |
Sealant - per tooth |
124 |
27 |
$4K |
| D9430 |
|
124 |
122 |
$4K |
| D4910 |
|
40 |
40 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
131 |
$2K |