| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,053 |
3,049 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,517 |
4,546 |
$95K |
| D1110 |
Prophylaxis - adult |
1,065 |
1,059 |
$90K |
| D1120 |
Prophylaxis - child |
2,114 |
2,108 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,887 |
2,884 |
$34K |
| D4910 |
|
370 |
370 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,412 |
2,405 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
378 |
243 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
282 |
$17K |
| D1206 |
Topical application of fluoride varnish |
885 |
879 |
$16K |
| D0350 |
|
1,361 |
679 |
$13K |
| D4341 |
|
205 |
58 |
$12K |
| D2140 |
|
152 |
91 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
77 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
70 |
$7K |
| D0274 |
Bitewings - four radiographic images |
180 |
180 |
$4K |
| D1351 |
Sealant - per tooth |
88 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$810.00 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$264.00 |