| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,003 |
5,001 |
$252K |
| D1120 |
Prophylaxis - child |
4,132 |
4,130 |
$146K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,681 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,524 |
1,032 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,515 |
6,346 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,709 |
1,169 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,668 |
3,665 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,845 |
5,843 |
$64K |
| D2140 |
|
1,025 |
769 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
657 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,940 |
1,913 |
$23K |
| D0272 |
Bitewings - two radiographic images |
704 |
704 |
$8K |
| D2160 |
|
39 |
30 |
$3K |
| D2330 |
|
41 |
24 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$428.00 |
| D9430 |
|
13 |
13 |
$416.00 |