| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,113 |
1,109 |
$61K |
| D1120 |
Prophylaxis - child |
1,319 |
1,317 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,985 |
1,542 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
413 |
413 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
230 |
92 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,253 |
1,244 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
209 |
$10K |
| D1206 |
Topical application of fluoride varnish |
906 |
905 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
441 |
440 |
$7K |
| D1110 |
Prophylaxis - adult |
70 |
70 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$168.00 |
| D1330 |
|
445 |
444 |
$0.00 |