| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
12,395 |
1,944 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,695 |
1,683 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
369 |
217 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,611 |
1,302 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
202 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
211 |
211 |
$8K |
| D1120 |
Prophylaxis - child |
242 |
238 |
$8K |
| D1110 |
Prophylaxis - adult |
99 |
99 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
12 |
$3K |
| D2140 |
|
56 |
37 |
$3K |
| D2160 |
|
31 |
25 |
$2K |
| D9430 |
|
12 |
12 |
$384.00 |