| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,561 |
3,549 |
$180K |
| D1120 |
Prophylaxis - child |
3,094 |
3,083 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,225 |
3,722 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,383 |
2,377 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,091 |
4,077 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
653 |
$39K |
| D4910 |
|
413 |
412 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
322 |
322 |
$15K |
| D4341 |
|
176 |
46 |
$12K |
| D1351 |
Sealant - per tooth |
535 |
118 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
698 |
$8K |
| D9430 |
|
153 |
146 |
$5K |
| D0350 |
|
372 |
177 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$3K |
| D9993 |
|
40 |
40 |
$3K |
| D1310 |
|
41 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
104 |
104 |
$1K |
| D0601 |
|
14 |
14 |
$210.00 |
| D1999 |
|
44 |
43 |
$0.00 |
| D0190 |
|
17 |
16 |
$0.00 |