| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,477 |
5,457 |
$392K |
| D1351 |
Sealant - per tooth |
4,791 |
1,172 |
$132K |
| D1120 |
Prophylaxis - child |
5,438 |
5,416 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,286 |
698 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
4,050 |
4,026 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
533 |
$54K |
| D2140 |
|
720 |
481 |
$39K |
| D1206 |
Topical application of fluoride varnish |
5,859 |
5,839 |
$17K |
| D0272 |
Bitewings - two radiographic images |
2,690 |
2,675 |
$12K |
| D0330 |
Panoramic radiographic image |
523 |
519 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,874 |
3,736 |
$8K |
| D1110 |
Prophylaxis - adult |
343 |
341 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
71 |
$8K |
| D0274 |
Bitewings - four radiographic images |
917 |
914 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
80 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D2160 |
|
16 |
13 |
$1K |