| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,537 |
2,526 |
$158K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,674 |
$144K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
807 |
367 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,527 |
1,518 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
774 |
764 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
352 |
212 |
$23K |
| D1120 |
Prophylaxis - child |
503 |
501 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,353 |
1,762 |
$17K |
| D2140 |
|
305 |
161 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,136 |
1,124 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,046 |
1,039 |
$15K |
| D0274 |
Bitewings - four radiographic images |
696 |
691 |
$15K |
| D9430 |
|
454 |
443 |
$14K |
| D4341 |
|
85 |
28 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
24 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
416 |
413 |
$5K |
| D4910 |
|
14 |
14 |
$1K |