| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,751 |
4,740 |
$259K |
| D1120 |
Prophylaxis - child |
4,486 |
4,482 |
$169K |
| D1110 |
Prophylaxis - adult |
1,056 |
1,054 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,264 |
795 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,216 |
5,578 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,584 |
3,580 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,686 |
5,673 |
$68K |
| D1351 |
Sealant - per tooth |
2,320 |
530 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
793 |
789 |
$49K |
| D2140 |
|
623 |
358 |
$34K |
| D4910 |
|
402 |
401 |
$31K |
| D9430 |
|
855 |
843 |
$27K |
| D0350 |
|
1,600 |
804 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,204 |
1,203 |
$14K |
| D4341 |
|
128 |
37 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
686 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
161 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
38 |
$3K |
| D2160 |
|
31 |
24 |
$2K |