| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,666 |
1,664 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
963 |
959 |
$58K |
| D1120 |
Prophylaxis - child |
1,593 |
1,587 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,372 |
2,838 |
$51K |
| D1110 |
Prophylaxis - adult |
455 |
450 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
449 |
241 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,572 |
2,563 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,398 |
1,392 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
134 |
86 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
153 |
$7K |
| D0250 |
|
260 |
246 |
$6K |
| D0272 |
Bitewings - two radiographic images |
621 |
415 |
$5K |
| D2160 |
|
45 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
225 |
$2K |
| D1351 |
Sealant - per tooth |
94 |
21 |
$2K |
| D9110 |
|
26 |
26 |
$2K |
| D0260 |
|
60 |
37 |
$405.00 |
| D1330 |
|
870 |
865 |
$0.00 |
| D1999 |
|
14 |
14 |
$0.00 |