| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
9,544 |
1,367 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
478 |
313 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
970 |
957 |
$31K |
| D1110 |
Prophylaxis - adult |
414 |
410 |
$28K |
| D2140 |
|
489 |
268 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
461 |
$24K |
| D1120 |
Prophylaxis - child |
651 |
650 |
$19K |
| D0350 |
|
1,316 |
746 |
$10K |
| D0272 |
Bitewings - two radiographic images |
932 |
926 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
59 |
$9K |
| D0274 |
Bitewings - four radiographic images |
251 |
250 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
200 |
81 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$3K |
| D4341 |
|
40 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
208 |
207 |
$2K |
| D2330 |
|
17 |
15 |
$1K |
| D9430 |
|
15 |
15 |
$392.00 |