| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,900 |
2,727 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,144 |
1,072 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,389 |
575 |
$52K |
| D1120 |
Prophylaxis - child |
854 |
768 |
$35K |
| D1110 |
Prophylaxis - adult |
752 |
703 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,422 |
1,309 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
175 |
118 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
879 |
843 |
$8K |
| D2140 |
|
135 |
108 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
132 |
$5K |
| D1351 |
Sealant - per tooth |
190 |
49 |
$4K |
| D9110 |
|
128 |
124 |
$3K |
| D0274 |
Bitewings - four radiographic images |
84 |
75 |
$2K |
| D2160 |
|
16 |
12 |
$932.79 |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
79 |
$666.93 |
| D9420 |
|
13 |
12 |
$642.20 |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$488.26 |