| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,040 |
4,026 |
$227K |
| D1120 |
Prophylaxis - child |
3,714 |
3,698 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,748 |
4,617 |
$101K |
| D1110 |
Prophylaxis - adult |
1,060 |
1,054 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,032 |
5,010 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
999 |
991 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,910 |
2,899 |
$62K |
| D1351 |
Sealant - per tooth |
1,890 |
480 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
562 |
362 |
$38K |
| D0350 |
|
3,670 |
1,660 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
741 |
738 |
$35K |
| D4910 |
|
416 |
416 |
$35K |
| D2160 |
|
289 |
204 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
369 |
199 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,564 |
1,550 |
$19K |
| D4341 |
|
104 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$1K |
| D2161 |
|
16 |
12 |
$1K |
| D9110 |
|
14 |
13 |
$803.25 |
| D9430 |
|
12 |
12 |
$384.00 |