| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,720 |
3,699 |
$204K |
| D1110 |
Prophylaxis - adult |
1,936 |
1,928 |
$164K |
| D4910 |
|
2,059 |
2,051 |
$158K |
| D1120 |
Prophylaxis - child |
2,162 |
2,152 |
$81K |
| D4341 |
|
1,214 |
340 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,145 |
4,127 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,235 |
2,223 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,533 |
1,599 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
369 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,090 |
1,069 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
158 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
120 |
90 |
$8K |
| D9430 |
|
255 |
254 |
$8K |
| D0272 |
Bitewings - two radiographic images |
558 |
557 |
$6K |
| D2140 |
|
23 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$803.60 |