| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,299 |
3,282 |
$183K |
| D1110 |
Prophylaxis - adult |
1,330 |
1,321 |
$111K |
| D1120 |
Prophylaxis - child |
2,807 |
2,786 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,143 |
4,216 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,242 |
1,236 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,566 |
3,512 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,498 |
3,470 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
559 |
555 |
$26K |
| D1351 |
Sealant - per tooth |
816 |
180 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
168 |
121 |
$19K |
| D9430 |
|
337 |
333 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
138 |
77 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
399 |
390 |
$5K |
| D0350 |
|
96 |
57 |
$660.00 |