| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,623 |
1,615 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
2,211 |
2,200 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,417 |
2,964 |
$71K |
| D1120 |
Prophylaxis - child |
1,509 |
1,504 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
812 |
812 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,292 |
3,279 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
631 |
631 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,438 |
1,433 |
$29K |
| D4910 |
|
231 |
231 |
$18K |
| D4341 |
|
149 |
41 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
98 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
685 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
25 |
$5K |
| D9430 |
|
135 |
134 |
$4K |
| D0272 |
Bitewings - two radiographic images |
373 |
373 |
$4K |
| D1351 |
Sealant - per tooth |
160 |
37 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$1K |