| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,949 |
1,930 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
2,243 |
2,229 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,420 |
1,407 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,073 |
1,067 |
$50K |
| D1120 |
Prophylaxis - child |
1,070 |
1,065 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,594 |
2,425 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,535 |
2,522 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
465 |
259 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,589 |
1,570 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
195 |
123 |
$13K |
| D0274 |
Bitewings - four radiographic images |
260 |
258 |
$5K |
| D9430 |
|
141 |
128 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
119 |
$1K |
| D2140 |
|
20 |
12 |
$1K |