| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,763 |
1,757 |
$113K |
| D1110 |
Prophylaxis - adult |
981 |
978 |
$87K |
| D1120 |
Prophylaxis - child |
1,374 |
1,370 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
782 |
$51K |
| D9430 |
|
1,075 |
945 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,250 |
1,245 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,721 |
1,716 |
$21K |
| D9110 |
|
341 |
327 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,910 |
1,882 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
299 |
$14K |
| D1206 |
Topical application of fluoride varnish |
609 |
606 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
32 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$3K |
| D0350 |
|
295 |
118 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$318.00 |
| D0270 |
|
12 |
12 |
$60.00 |