| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,446 |
1,433 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
841 |
$49K |
| D2140 |
|
655 |
432 |
$36K |
| D1120 |
Prophylaxis - child |
1,009 |
1,006 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,362 |
1,349 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
349 |
255 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
524 |
524 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,683 |
1,680 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,122 |
1,580 |
$12K |
| D0350 |
|
992 |
630 |
$9K |
| D4341 |
|
107 |
25 |
$7K |
| D1110 |
Prophylaxis - adult |
67 |
67 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
291 |
259 |
$3K |
| D1351 |
Sealant - per tooth |
121 |
26 |
$3K |
| D9430 |
|
70 |
60 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$708.00 |