| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,991 |
2,890 |
$66K |
| D1120 |
Prophylaxis - child |
1,471 |
1,423 |
$61K |
| D2160 |
|
626 |
454 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,002 |
1,941 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
511 |
344 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
886 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
614 |
591 |
$17K |
| D1351 |
Sealant - per tooth |
186 |
95 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
218 |
173 |
$12K |
| D2140 |
|
266 |
219 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,882 |
1,796 |
$11K |
| D2332 |
|
68 |
52 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
867 |
801 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
192 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
98 |
93 |
$938.84 |