| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,080 |
7,067 |
$396K |
| D1120 |
Prophylaxis - child |
6,987 |
6,969 |
$269K |
| D0274 |
Bitewings - four radiographic images |
5,882 |
5,867 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,057 |
8,086 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,781 |
7,761 |
$90K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
656 |
464 |
$44K |
| D1110 |
Prophylaxis - adult |
436 |
436 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,827 |
2,653 |
$33K |
| D1351 |
Sealant - per tooth |
1,366 |
527 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
295 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,286 |
1,286 |
$15K |
| D9430 |
|
231 |
226 |
$7K |
| D2160 |
|
81 |
68 |
$6K |
| D2140 |
|
53 |
42 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
28 |
$2K |