| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,152 |
3,136 |
$168K |
| D1110 |
Prophylaxis - adult |
1,262 |
1,257 |
$105K |
| D1120 |
Prophylaxis - child |
2,764 |
2,756 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,496 |
3,297 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,096 |
603 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
842 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,978 |
2,970 |
$35K |
| D2140 |
|
502 |
295 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
580 |
574 |
$26K |
| D0350 |
|
2,285 |
1,210 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,576 |
1,571 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
82 |
$9K |
| D1351 |
Sealant - per tooth |
101 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
102 |
$1K |
| D1203 |
|
12 |
12 |
$0.00 |