| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,667 |
5,663 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
10,470 |
10,451 |
$236K |
| D1120 |
Prophylaxis - child |
4,898 |
4,882 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,673 |
9,656 |
$140K |
| D0274 |
Bitewings - four radiographic images |
4,948 |
4,948 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,012 |
6,996 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
9,690 |
9,673 |
$84K |
| D2140 |
|
1,581 |
1,328 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
966 |
838 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
485 |
419 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,126 |
1,126 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,518 |
1,510 |
$11K |
| D1351 |
Sealant - per tooth |
161 |
85 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
95 |
$2K |
| D0240 |
|
64 |
64 |
$1K |