| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,790 |
2,786 |
$113K |
| D1120 |
Prophylaxis - child |
2,534 |
2,524 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,126 |
2,733 |
$75K |
| D1110 |
Prophylaxis - adult |
728 |
727 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
484 |
310 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
387 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
484 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,079 |
2,073 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
361 |
265 |
$21K |
| D0274 |
Bitewings - four radiographic images |
951 |
951 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,619 |
1,614 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
58 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
39 |
$3K |