| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,173 |
1,169 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,352 |
1,347 |
$67K |
| D1110 |
Prophylaxis - adult |
735 |
730 |
$60K |
| D1120 |
Prophylaxis - child |
798 |
793 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,438 |
1,431 |
$17K |
| D2140 |
|
181 |
100 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
24 |
$8K |
| D0330 |
Panoramic radiographic image |
257 |
256 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
144 |
$7K |
| D1351 |
Sealant - per tooth |
195 |
39 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
46 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
911 |
428 |
$4K |
| D4341 |
|
49 |
13 |
$3K |