| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,200 |
4,195 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,908 |
1,116 |
$127K |
| D1120 |
Prophylaxis - child |
3,392 |
3,390 |
$127K |
| D2160 |
|
956 |
662 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,377 |
1,376 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,768 |
2,766 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
881 |
$53K |
| D1351 |
Sealant - per tooth |
2,077 |
488 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,128 |
4,122 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,712 |
3,890 |
$39K |
| D4341 |
|
463 |
156 |
$29K |
| D1110 |
Prophylaxis - adult |
334 |
332 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
469 |
$5K |
| D0272 |
Bitewings - two radiographic images |
446 |
446 |
$5K |
| D9430 |
|
91 |
90 |
$3K |