| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,949 |
1,938 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
1,496 |
1,494 |
$59K |
| D1120 |
Prophylaxis - child |
1,661 |
1,650 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,604 |
2,676 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
612 |
346 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
783 |
$36K |
| D0330 |
Panoramic radiographic image |
713 |
712 |
$21K |
| D0274 |
Bitewings - four radiographic images |
961 |
959 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,960 |
1,947 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,495 |
1,326 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
55 |
$15K |
| D9430 |
|
425 |
413 |
$13K |
| D1110 |
Prophylaxis - adult |
116 |
115 |
$10K |
| D2160 |
|
89 |
62 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
29 |
13 |
$7K |
| D2140 |
|
79 |
44 |
$4K |
| D0272 |
Bitewings - two radiographic images |
371 |
368 |
$4K |
| D1351 |
Sealant - per tooth |
105 |
30 |
$2K |