| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,002 |
1,999 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,307 |
1,304 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,298 |
3,352 |
$75K |
| D4910 |
|
957 |
957 |
$72K |
| D1110 |
Prophylaxis - adult |
585 |
585 |
$49K |
| D1120 |
Prophylaxis - child |
1,340 |
1,336 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,857 |
1,853 |
$39K |
| D9430 |
|
1,198 |
1,147 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,656 |
2,649 |
$32K |
| D0330 |
Panoramic radiographic image |
897 |
892 |
$25K |
| D0350 |
|
2,268 |
913 |
$21K |
| D4341 |
|
292 |
79 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
271 |
131 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
101 |
$15K |
| D0272 |
Bitewings - two radiographic images |
861 |
860 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
234 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
40 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
584 |
566 |
$7K |
| D2140 |
|
61 |
36 |
$3K |
| D1351 |
Sealant - per tooth |
100 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$982.80 |