| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,758 |
1,756 |
$107K |
| D1110 |
Prophylaxis - adult |
1,217 |
1,215 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
1,641 |
1,637 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,153 |
1,152 |
$54K |
| D1120 |
Prophylaxis - child |
1,693 |
1,687 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
632 |
334 |
$42K |
| D1351 |
Sealant - per tooth |
1,542 |
319 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
195 |
108 |
$23K |
| D4341 |
|
326 |
87 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,670 |
1,666 |
$17K |
| D4910 |
|
215 |
215 |
$17K |
| D0274 |
Bitewings - four radiographic images |
721 |
719 |
$15K |
| D0272 |
Bitewings - two radiographic images |
904 |
903 |
$10K |
| D2954 |
|
85 |
65 |
$9K |
| D2160 |
|
63 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,073 |
542 |
$4K |
| D9430 |
|
77 |
77 |
$2K |
| D2140 |
|
41 |
28 |
$2K |
| D2931 |
|
15 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
64 |
$744.00 |