| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
492 |
486 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,542 |
1,405 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
566 |
561 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
340 |
$18K |
| D1120 |
Prophylaxis - child |
283 |
283 |
$8K |
| D0274 |
Bitewings - four radiographic images |
341 |
341 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
156 |
$7K |
| D9430 |
|
148 |
145 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
195 |
195 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
14 |
$1K |
| D0270 |
|
61 |
60 |
$295.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$257.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$236.00 |
| D1203 |
|
76 |
76 |
$152.00 |