| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,349 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
888 |
886 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
862 |
860 |
$40K |
| D1120 |
Prophylaxis - child |
1,166 |
1,159 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,538 |
1,746 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
279 |
161 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
418 |
233 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,598 |
1,585 |
$16K |
| D0274 |
Bitewings - four radiographic images |
748 |
745 |
$15K |
| D1110 |
Prophylaxis - adult |
153 |
152 |
$11K |
| D9430 |
|
249 |
245 |
$8K |
| D1351 |
Sealant - per tooth |
229 |
64 |
$5K |
| D0350 |
|
522 |
261 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
333 |
323 |
$4K |
| D2394 |
|
41 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
257 |
257 |
$3K |
| D2160 |
|
20 |
12 |
$2K |