| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,560 |
5,553 |
$255K |
| D1120 |
Prophylaxis - child |
5,909 |
5,901 |
$252K |
| D1351 |
Sealant - per tooth |
6,624 |
2,067 |
$210K |
| D1206 |
Topical application of fluoride varnish |
6,060 |
6,051 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
6,841 |
6,726 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,389 |
3,384 |
$72K |
| D9999 |
Unspecified adjunctive procedure, by report |
687 |
665 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
870 |
611 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,699 |
6,253 |
$43K |
| D1310 |
|
1,183 |
1,180 |
$39K |
| D2140 |
|
723 |
558 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
460 |
460 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,175 |
2,173 |
$18K |
| D0999 |
Unspecified diagnostic procedure, by report |
211 |
211 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
42 |
$7K |
| D0603 |
|
713 |
712 |
$6K |
| D9430 |
|
192 |
184 |
$5K |
| D1320 |
|
389 |
389 |
$3K |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$2K |
| D0601 |
|
446 |
446 |
$2K |
| D0602 |
|
262 |
261 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
17 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$1K |
| D7111 |
|
29 |
14 |
$1K |
| D1999 |
|
53 |
52 |
$520.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$350.00 |
| D9993 |
|
621 |
618 |
$270.00 |
| D9986 |
|
318 |
304 |
$0.00 |
| D9987 |
|
44 |
44 |
$0.00 |