| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,319 |
3,301 |
$175K |
| D1120 |
Prophylaxis - child |
2,545 |
2,530 |
$94K |
| D1110 |
Prophylaxis - adult |
1,077 |
1,070 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,881 |
3,261 |
$56K |
| D4910 |
|
608 |
607 |
$47K |
| D0272 |
Bitewings - two radiographic images |
3,282 |
3,265 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,525 |
2,515 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
569 |
401 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
425 |
288 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,324 |
1,269 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
218 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
830 |
$8K |
| D1351 |
Sealant - per tooth |
284 |
104 |
$6K |
| D2140 |
|
98 |
74 |
$5K |
| D9430 |
|
127 |
124 |
$4K |
| D2330 |
|
23 |
14 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$1K |