| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
29,185 |
5,403 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,031 |
2,026 |
$100K |
| D1120 |
Prophylaxis - child |
2,692 |
2,677 |
$100K |
| D1110 |
Prophylaxis - adult |
875 |
868 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,723 |
4,689 |
$58K |
| D0272 |
Bitewings - two radiographic images |
4,919 |
4,880 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
852 |
836 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
430 |
254 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
78 |
$13K |
| D0350 |
|
210 |
87 |
$2K |
| D2140 |
|
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
54 |
$594.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$480.00 |