| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
12,868 |
2,152 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,345 |
1,328 |
$53K |
| D1120 |
Prophylaxis - child |
1,448 |
1,435 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
493 |
278 |
$32K |
| D1351 |
Sealant - per tooth |
1,436 |
446 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,361 |
1,352 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,903 |
1,892 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
335 |
$17K |
| D0350 |
|
1,500 |
681 |
$15K |
| D2140 |
|
234 |
152 |
$13K |
| D1110 |
Prophylaxis - adult |
161 |
159 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
14 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
24 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
143 |
$6K |
| D7111 |
|
86 |
43 |
$5K |
| D0272 |
Bitewings - two radiographic images |
400 |
396 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
380 |
375 |
$4K |
| D4341 |
|
46 |
12 |
$3K |
| D9110 |
|
14 |
12 |
$756.00 |