| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,064 |
6,045 |
$334K |
| D1120 |
Prophylaxis - child |
5,618 |
5,573 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,089 |
8,149 |
$183K |
| D1110 |
Prophylaxis - adult |
1,275 |
1,270 |
$108K |
| D2140 |
|
1,771 |
786 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,662 |
673 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,436 |
1,434 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,431 |
7,378 |
$82K |
| D0272 |
Bitewings - two radiographic images |
6,691 |
6,653 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
861 |
524 |
$58K |
| D0350 |
|
5,623 |
2,405 |
$55K |
| D4910 |
|
81 |
81 |
$6K |
| D9430 |
|
131 |
118 |
$4K |
| D4341 |
|
59 |
16 |
$4K |
| D2330 |
|
47 |
30 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$910.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D1310 |
|
15 |
15 |
$0.00 |