| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,018 |
1,018 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,254 |
1,250 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,353 |
1,351 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,053 |
3,177 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,387 |
3,914 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
405 |
263 |
$48K |
| D1120 |
Prophylaxis - child |
1,101 |
1,098 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,454 |
2,448 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
320 |
160 |
$18K |
| D1351 |
Sealant - per tooth |
594 |
123 |
$13K |
| D2140 |
|
147 |
96 |
$8K |
| D9430 |
|
150 |
148 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
26 |
$3K |
| D0350 |
|
174 |
107 |
$1K |