| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,593 |
2,576 |
$136K |
| D1110 |
Prophylaxis - adult |
922 |
921 |
$78K |
| D1120 |
Prophylaxis - child |
2,086 |
2,070 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,608 |
2,705 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
755 |
478 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,882 |
1,872 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
592 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
754 |
752 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
262 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,958 |
1,944 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,064 |
1,031 |
$12K |
| D9430 |
|
306 |
301 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
28 |
$4K |
| D2160 |
|
47 |
36 |
$4K |
| D2140 |
|
47 |
30 |
$3K |
| D0272 |
Bitewings - two radiographic images |
151 |
150 |
$2K |
| D0350 |
|
195 |
134 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
25 |
$2K |