| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,948 |
6,947 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
9,203 |
9,199 |
$209K |
| D0210 |
Intraoral - complete series of radiographic images |
1,973 |
1,960 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
5,769 |
5,726 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,016 |
2,016 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,124 |
4,113 |
$33K |
| D1120 |
Prophylaxis - child |
628 |
628 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
365 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
883 |
875 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
781 |
781 |
$9K |
| D0272 |
Bitewings - two radiographic images |
254 |
254 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
32 |
$2K |
| D2140 |
|
26 |
26 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$918.00 |