| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,031 |
5,015 |
$275K |
| D1110 |
Prophylaxis - adult |
2,469 |
2,455 |
$204K |
| D1120 |
Prophylaxis - child |
4,983 |
4,959 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,526 |
2,513 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,477 |
5,277 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,461 |
6,436 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,669 |
1,668 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
624 |
212 |
$74K |
| D2140 |
|
1,272 |
633 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,267 |
3,249 |
$67K |
| D9430 |
|
1,356 |
1,318 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
597 |
375 |
$39K |
| D0350 |
|
3,163 |
1,526 |
$34K |
| D1206 |
Topical application of fluoride varnish |
939 |
931 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,151 |
1,151 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
965 |
948 |
$12K |
| D9993 |
|
171 |
168 |
$11K |
| D1351 |
Sealant - per tooth |
312 |
68 |
$10K |
| D1310 |
|
197 |
194 |
$8K |
| D0330 |
Panoramic radiographic image |
269 |
268 |
$7K |
| D1320 |
|
351 |
351 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
15 |
$4K |
| D0601 |
|
213 |
210 |
$3K |