| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,060 |
1,060 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,116 |
1,690 |
$37K |
| D1110 |
Prophylaxis - adult |
352 |
352 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,224 |
1,224 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
444 |
443 |
$25K |
| D1120 |
Prophylaxis - child |
844 |
839 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
389 |
174 |
$22K |
| D1351 |
Sealant - per tooth |
826 |
212 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,309 |
1,304 |
$13K |
| D4910 |
|
130 |
130 |
$10K |
| D4341 |
|
130 |
36 |
$9K |
| D9430 |
|
242 |
237 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
617 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
26 |
$2K |
| D2140 |
|
33 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$312.00 |