| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,779 |
1,771 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
875 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
754 |
460 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,016 |
2,346 |
$47K |
| D1120 |
Prophylaxis - child |
1,537 |
1,530 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
319 |
135 |
$37K |
| D2160 |
|
311 |
218 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,930 |
1,751 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,038 |
2,028 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
421 |
416 |
$19K |
| D0274 |
Bitewings - four radiographic images |
862 |
862 |
$18K |
| D2140 |
|
252 |
149 |
$13K |
| D1110 |
Prophylaxis - adult |
173 |
173 |
$12K |
| D0350 |
|
1,232 |
639 |
$11K |
| D4341 |
|
143 |
42 |
$8K |
| D0272 |
Bitewings - two radiographic images |
337 |
334 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
27 |
$3K |