| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,188 |
2,186 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
3,285 |
3,273 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,524 |
4,152 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,184 |
3,181 |
$67K |
| D1120 |
Prophylaxis - child |
1,745 |
1,741 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
798 |
796 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
1,025 |
996 |
$12K |
| D1206 |
Topical application of fluoride varnish |
923 |
921 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
95 |
$7K |
| D9430 |
|
153 |
151 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
38 |
$4K |
| D2140 |
|
26 |
16 |
$1K |
| D2330 |
|
16 |
12 |
$1K |
| D0350 |
|
38 |
17 |
$210.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$110.00 |