| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,229 |
2,213 |
$138K |
| D1110 |
Prophylaxis - adult |
1,324 |
1,316 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,688 |
1,682 |
$110K |
| D1120 |
Prophylaxis - child |
2,181 |
2,172 |
$84K |
| D9430 |
|
1,143 |
1,119 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
764 |
762 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,827 |
2,810 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
341 |
195 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,439 |
1,595 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,122 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
41 |
$7K |
| D2160 |
|
23 |
12 |
$2K |
| D1999 |
|
14 |
14 |
$0.00 |