| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
449 |
444 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
299 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
508 |
484 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
140 |
74 |
$10K |
| D1999 |
|
247 |
216 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
1,031 |
$3K |
| D0274 |
Bitewings - four radiographic images |
690 |
676 |
$2K |
| D1110 |
Prophylaxis - adult |
539 |
529 |
$2K |
| D1120 |
Prophylaxis - child |
38 |
38 |
$1K |
| D0330 |
Panoramic radiographic image |
255 |
248 |
$430.00 |
| CR199 |
|
177 |
127 |
$328.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
795 |
712 |
$297.98 |
| D1206 |
Topical application of fluoride varnish |
92 |
92 |
$0.00 |