| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,446 |
2,408 |
$51K |
| D1120 |
Prophylaxis - child |
1,399 |
1,399 |
$42K |
| D1110 |
Prophylaxis - adult |
884 |
884 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,036 |
2,036 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
294 |
203 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
382 |
216 |
$25K |
| D0274 |
Bitewings - four radiographic images |
805 |
805 |
$24K |
| D0330 |
Panoramic radiographic image |
395 |
395 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
393 |
$12K |
| D1320 |
|
334 |
329 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
754 |
743 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
250 |
$8K |
| D4341 |
|
27 |
12 |
$4K |
| D0601 |
|
229 |
229 |
$2K |
| D1351 |
Sealant - per tooth |
63 |
15 |
$1K |
| D2140 |
|
19 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$971.64 |
| D0602 |
|
32 |
32 |
$292.80 |
| D0603 |
|
15 |
15 |
$137.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
13 |
$129.54 |