| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
853 |
825 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
339 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
406 |
400 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
958 |
914 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
308 |
177 |
$19K |
| D2140 |
|
140 |
88 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
134 |
70 |
$9K |
| D1120 |
Prophylaxis - child |
509 |
502 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
12 |
$260.40 |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$217.02 |
| D0330 |
Panoramic radiographic image |
242 |
234 |
$216.69 |
| D0272 |
Bitewings - two radiographic images |
358 |
351 |
$171.72 |
| D0274 |
Bitewings - four radiographic images |
384 |
373 |
$161.64 |
| D1206 |
Topical application of fluoride varnish |
483 |
477 |
$17.72 |