| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,221 |
3,216 |
$141K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,845 |
871 |
$121K |
| D1120 |
Prophylaxis - child |
3,457 |
3,454 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,579 |
1,579 |
$96K |
| D1110 |
Prophylaxis - adult |
1,116 |
1,115 |
$90K |
| D2140 |
|
1,379 |
618 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,815 |
4,809 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,116 |
1,114 |
$51K |
| D1351 |
Sealant - per tooth |
1,964 |
443 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,222 |
3,570 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,724 |
2,721 |
$32K |
| D4341 |
|
362 |
95 |
$24K |
| D0350 |
|
2,201 |
975 |
$21K |
| D0274 |
Bitewings - four radiographic images |
293 |
293 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
12 |
$5K |
| D2160 |
|
50 |
34 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
37 |
$4K |
| D2330 |
|
25 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
74 |
$840.00 |