| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,996 |
1,858 |
$88K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
775 |
427 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,030 |
956 |
$44K |
| D1351 |
Sealant - per tooth |
1,552 |
396 |
$41K |
| D2140 |
|
645 |
399 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,639 |
1,552 |
$33K |
| D0272 |
Bitewings - two radiographic images |
383 |
358 |
$16K |
| D2160 |
|
136 |
87 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
567 |
510 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
66 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,626 |
1,384 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
205 |
$2K |
| D1120 |
Prophylaxis - child |
1,580 |
1,472 |
$989.00 |
| D1110 |
Prophylaxis - adult |
311 |
293 |
$672.28 |
| D1206 |
Topical application of fluoride varnish |
2,161 |
2,040 |
$222.32 |
| D0330 |
Panoramic radiographic image |
33 |
29 |
$124.97 |
| D4910 |
|
42 |
41 |
$0.00 |