| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,326 |
3,232 |
$200K |
| D1110 |
Prophylaxis - adult |
1,940 |
1,883 |
$162K |
| D1120 |
Prophylaxis - child |
1,836 |
1,794 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,250 |
3,695 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,902 |
2,838 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,584 |
3,491 |
$43K |
| D4910 |
|
467 |
456 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
434 |
425 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
251 |
113 |
$17K |
| D2330 |
|
104 |
47 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
561 |
535 |
$7K |
| D1351 |
Sealant - per tooth |
324 |
71 |
$6K |
| D9430 |
|
125 |
125 |
$4K |
| D2140 |
|
55 |
27 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
14 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
14 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
14 |
$2K |
| D2954 |
|
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$672.00 |
| D0272 |
Bitewings - two radiographic images |
52 |
42 |
$624.00 |