| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,643 |
2,617 |
$140K |
| D1120 |
Prophylaxis - child |
3,074 |
3,052 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
1,150 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,950 |
3,923 |
$54K |
| D1310 |
|
1,145 |
1,136 |
$51K |
| D9993 |
|
768 |
767 |
$47K |
| D1351 |
Sealant - per tooth |
1,758 |
375 |
$43K |
| D1110 |
Prophylaxis - adult |
511 |
510 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,629 |
3,389 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,337 |
1,336 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
383 |
214 |
$25K |
| D9430 |
|
623 |
602 |
$20K |
| D0603 |
|
1,081 |
1,072 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,229 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
91 |
$10K |
| D1354 |
|
266 |
266 |
$9K |
| D2140 |
|
106 |
59 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
15 |
$3K |
| D1320 |
|
145 |
145 |
$2K |
| D0272 |
Bitewings - two radiographic images |
178 |
178 |
$2K |
| D2160 |
|
18 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$1K |
| D0602 |
|
13 |
13 |
$195.00 |