| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,066 |
1,052 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,952 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
931 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,153 |
2,131 |
$42K |
| D1120 |
Prophylaxis - child |
1,213 |
1,201 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,454 |
2,643 |
$33K |
| D4341 |
|
203 |
56 |
$14K |
| D1206 |
Topical application of fluoride varnish |
984 |
979 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
621 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
28 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
105 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
25 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
118 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
106 |
103 |
$984.12 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |