| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,489 |
2,476 |
$121K |
| D4910 |
|
1,402 |
1,400 |
$107K |
| D1110 |
Prophylaxis - adult |
1,256 |
1,247 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
866 |
577 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,466 |
4,209 |
$73K |
| D1120 |
Prophylaxis - child |
1,922 |
1,909 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,030 |
1,028 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,004 |
1,991 |
$41K |
| D4341 |
|
432 |
123 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
397 |
196 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,693 |
1,684 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,487 |
1,483 |
$17K |
| D2335 |
|
140 |
30 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
341 |
$15K |
| D9430 |
|
446 |
445 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,031 |
1,001 |
$12K |
| D1320 |
|
258 |
257 |
$4K |
| D0272 |
Bitewings - two radiographic images |
348 |
345 |
$4K |
| D0350 |
|
366 |
180 |
$3K |
| D2140 |
|
50 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$975.80 |