| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,886 |
2,869 |
$151K |
| D1120 |
Prophylaxis - child |
2,561 |
2,547 |
$93K |
| D1110 |
Prophylaxis - adult |
941 |
936 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,504 |
3,317 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
753 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,894 |
2,873 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,291 |
2,279 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
143 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
213 |
211 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
78 |
$9K |
| D0350 |
|
879 |
468 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
307 |
$4K |
| D9430 |
|
13 |
12 |
$416.00 |