| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,395 |
2,357 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,995 |
2,951 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
823 |
470 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,059 |
453 |
$51K |
| D1110 |
Prophylaxis - adult |
990 |
976 |
$44K |
| D2335 |
|
213 |
110 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
356 |
353 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
64 |
$4K |
| D2160 |
|
54 |
40 |
$3K |
| D1120 |
Prophylaxis - child |
48 |
47 |
$2K |
| D2332 |
|
23 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
19 |
18 |
$440.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$299.92 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$68.16 |