| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,604 |
3,526 |
$87K |
| D1110 |
Prophylaxis - adult |
2,050 |
1,984 |
$83K |
| D0330 |
Panoramic radiographic image |
1,922 |
1,864 |
$70K |
| D1120 |
Prophylaxis - child |
1,006 |
988 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,232 |
2,189 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
682 |
277 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,372 |
1,333 |
$21K |
| D0274 |
Bitewings - four radiographic images |
808 |
780 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
607 |
588 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,367 |
1,311 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
197 |
120 |
$11K |
| D2140 |
|
97 |
56 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
157 |
153 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
532 |
498 |
$3K |
| D2160 |
|
31 |
18 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
13 |
$1K |
| D9986 |
|
413 |
315 |
$0.00 |
| D9987 |
|
63 |
49 |
$0.00 |