| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,577 |
4,555 |
$222K |
| D1110 |
Prophylaxis - adult |
1,752 |
1,744 |
$144K |
| D1120 |
Prophylaxis - child |
3,483 |
3,454 |
$120K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,708 |
937 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,484 |
788 |
$82K |
| D2140 |
|
1,211 |
729 |
$65K |
| D1352 |
|
2,593 |
734 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,106 |
3,065 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,226 |
5,192 |
$61K |
| D4341 |
|
785 |
220 |
$53K |
| D9110 |
|
532 |
421 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,791 |
2,766 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,508 |
1,979 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
510 |
506 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,117 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
313 |
$18K |
| D2330 |
|
232 |
135 |
$17K |
| D2160 |
|
19 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$1K |