| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,878 |
3,866 |
$205K |
| D1120 |
Prophylaxis - child |
3,377 |
3,366 |
$125K |
| D0274 |
Bitewings - four radiographic images |
2,215 |
2,210 |
$46K |
| D1110 |
Prophylaxis - adult |
540 |
537 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,242 |
4,429 |
$38K |
| D9430 |
|
788 |
768 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,703 |
1,651 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,091 |
2,088 |
$18K |
| D1206 |
Topical application of fluoride varnish |
933 |
930 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
114 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,029 |
968 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
217 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
154 |
$10K |
| D1351 |
Sealant - per tooth |
378 |
67 |
$8K |
| D0350 |
|
227 |
169 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
17 |
$1K |
| D9110 |
|
12 |
12 |
$756.00 |