| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,885 |
4,882 |
$102K |
| D1110 |
Prophylaxis - adult |
2,658 |
2,656 |
$87K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,300 |
1,002 |
$79K |
| D1120 |
Prophylaxis - child |
1,531 |
1,531 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,437 |
3,437 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,060 |
4,060 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,112 |
2,112 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,812 |
3,811 |
$16K |
| D1351 |
Sealant - per tooth |
171 |
127 |
$13K |
| D2140 |
|
280 |
239 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
635 |
635 |
$9K |
| D0330 |
Panoramic radiographic image |
383 |
382 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
24 |
$966.52 |
| D9110 |
|
55 |
54 |
$694.19 |
| D2160 |
|
15 |
15 |
$626.82 |