| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,051 |
6,016 |
$337K |
| D1351 |
Sealant - per tooth |
9,484 |
2,230 |
$263K |
| D1110 |
Prophylaxis - adult |
2,598 |
2,586 |
$223K |
| D1120 |
Prophylaxis - child |
5,806 |
5,768 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,381 |
3,368 |
$214K |
| D2140 |
|
3,570 |
2,121 |
$195K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,302 |
1,544 |
$154K |
| D0210 |
Intraoral - complete series of radiographic images |
2,467 |
2,461 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,423 |
8,375 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,568 |
4,998 |
$78K |
| D0272 |
Bitewings - two radiographic images |
6,038 |
5,994 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,611 |
2,974 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
386 |
222 |
$46K |
| D0350 |
|
3,956 |
2,386 |
$37K |
| D9430 |
|
836 |
805 |
$27K |
| D4341 |
|
219 |
56 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
69 |
$8K |
| D2160 |
|
94 |
77 |
$8K |
| D2330 |
|
93 |
71 |
$7K |
| D0274 |
Bitewings - four radiographic images |
199 |
199 |
$4K |
| D1320 |
|
97 |
97 |
$1K |