| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,875 |
4,852 |
$281K |
| D1110 |
Prophylaxis - adult |
2,410 |
2,398 |
$210K |
| D1120 |
Prophylaxis - child |
4,165 |
4,146 |
$162K |
| D0274 |
Bitewings - four radiographic images |
4,413 |
4,394 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,590 |
6,558 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,289 |
1,282 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,339 |
6,468 |
$57K |
| D2160 |
|
486 |
248 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
446 |
445 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,693 |
1,601 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
313 |
197 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,178 |
1,170 |
$14K |
| D9110 |
|
136 |
134 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
53 |
$5K |
| D2161 |
|
42 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
68 |
28 |
$2K |