| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,154 |
4,131 |
$237K |
| D1110 |
Prophylaxis - adult |
2,531 |
2,515 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,573 |
2,554 |
$163K |
| D1120 |
Prophylaxis - child |
3,603 |
3,587 |
$142K |
| D0274 |
Bitewings - four radiographic images |
5,136 |
5,106 |
$109K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,336 |
957 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,514 |
845 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,213 |
7,032 |
$69K |
| D2140 |
|
1,110 |
761 |
$60K |
| D9430 |
|
800 |
773 |
$25K |
| D0350 |
|
2,303 |
1,483 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,719 |
1,708 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,618 |
1,580 |
$19K |
| D2330 |
|
174 |
107 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,060 |
1,053 |
$13K |
| D2160 |
|
15 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$709.80 |