| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,662 |
2,657 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
2,781 |
2,758 |
$170K |
| D1120 |
Prophylaxis - child |
3,304 |
3,285 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,244 |
5,213 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,780 |
817 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,485 |
2,474 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,057 |
4,032 |
$50K |
| D9430 |
|
1,505 |
1,449 |
$48K |
| D1110 |
Prophylaxis - adult |
544 |
540 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
707 |
398 |
$47K |
| D1351 |
Sealant - per tooth |
2,037 |
452 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
915 |
912 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
143 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
154 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
154 |
$14K |
| D9993 |
|
299 |
299 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,012 |
1,000 |
$12K |
| D1310 |
|
298 |
298 |
$12K |
| D0272 |
Bitewings - two radiographic images |
609 |
604 |
$7K |
| D4341 |
|
68 |
18 |
$5K |
| D4910 |
|
27 |
27 |
$2K |
| D2160 |
|
14 |
12 |
$1K |
| D0601 |
|
44 |
44 |
$610.00 |
| D0270 |
|
68 |
68 |
$335.00 |