| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,412 |
3,411 |
$151K |
| D1120 |
Prophylaxis - child |
3,309 |
3,306 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,423 |
1,036 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
1,197 |
$74K |
| D9110 |
|
1,099 |
982 |
$68K |
| D2140 |
|
1,031 |
753 |
$55K |
| D0272 |
Bitewings - two radiographic images |
4,405 |
4,404 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,857 |
3,845 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,820 |
1,782 |
$32K |
| D9430 |
|
865 |
855 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,921 |
1,828 |
$22K |
| D1110 |
Prophylaxis - adult |
226 |
226 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
87 |
$14K |
| D4341 |
|
183 |
51 |
$13K |
| D0350 |
|
1,438 |
1,156 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
76 |
$6K |
| D4910 |
|
25 |
25 |
$2K |