| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,120 |
5,098 |
$267K |
| D1120 |
Prophylaxis - child |
4,467 |
4,443 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,242 |
6,531 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,643 |
1,639 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,464 |
842 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,100 |
4,074 |
$86K |
| D1110 |
Prophylaxis - adult |
853 |
847 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,342 |
5,313 |
$61K |
| D4341 |
|
692 |
200 |
$48K |
| D1351 |
Sealant - per tooth |
1,692 |
377 |
$44K |
| D4910 |
|
471 |
468 |
$36K |
| D9430 |
|
1,018 |
998 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
213 |
115 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
389 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,385 |
1,381 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
723 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
64 |
$6K |
| D2160 |
|
34 |
27 |
$3K |
| D0350 |
|
307 |
185 |
$3K |
| D2140 |
|
36 |
29 |
$2K |
| D1206 |
Topical application of fluoride varnish |
115 |
114 |
$990.00 |
| D9993 |
|
13 |
13 |
$780.00 |
| D1310 |
|
13 |
13 |
$552.00 |
| D0270 |
|
44 |
44 |
$210.00 |
| D0603 |
|
12 |
12 |
$165.00 |