| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,012 |
1,999 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,168 |
1,161 |
$71K |
| D1120 |
Prophylaxis - child |
1,677 |
1,663 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,110 |
2,060 |
$42K |
| D4910 |
|
521 |
515 |
$40K |
| D9430 |
|
984 |
824 |
$30K |
| D1110 |
Prophylaxis - adult |
348 |
346 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
630 |
623 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,220 |
1,207 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,732 |
1,716 |
$19K |
| D0350 |
|
2,201 |
1,016 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
61 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
66 |
$8K |
| D4341 |
|
99 |
29 |
$7K |
| D1206 |
Topical application of fluoride varnish |
302 |
302 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
122 |
118 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
49 |
$588.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$138.00 |