| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,776 |
2,749 |
$67K |
| D1110 |
Prophylaxis - adult |
1,518 |
1,488 |
$61K |
| D1120 |
Prophylaxis - child |
1,595 |
1,554 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
844 |
441 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,282 |
2,231 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,283 |
1,197 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,359 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
84 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
434 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,057 |
1,009 |
$11K |
| D2140 |
|
211 |
130 |
$10K |
| D0602 |
|
234 |
233 |
$3K |
| D0603 |
|
222 |
220 |
$2K |
| D0601 |
|
180 |
178 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
54 |
$780.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$560.00 |
| D1999 |
|
69 |
61 |
$427.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$260.00 |
| D1330 |
|
72 |
71 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |