| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,808 |
1,803 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
2,381 |
2,373 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,517 |
1,514 |
$91K |
| D1120 |
Prophylaxis - child |
1,977 |
1,975 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,048 |
3,043 |
$64K |
| D9430 |
|
1,474 |
1,419 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,299 |
3,295 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,856 |
1,778 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,371 |
2,081 |
$13K |
| D2160 |
|
77 |
70 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
58 |
$5K |
| D0272 |
Bitewings - two radiographic images |
251 |
250 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$1K |
| D7510 |
|
15 |
14 |
$980.00 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$512.00 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$480.00 |