| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,567 |
1,543 |
$60K |
| D1110 |
Prophylaxis - adult |
771 |
762 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
823 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
387 |
260 |
$44K |
| D9430 |
|
1,010 |
872 |
$31K |
| D1120 |
Prophylaxis - child |
1,004 |
996 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
637 |
631 |
$27K |
| D4341 |
|
358 |
154 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,457 |
1,640 |
$18K |
| D0274 |
Bitewings - four radiographic images |
925 |
919 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
936 |
922 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
148 |
92 |
$10K |
| D1206 |
Topical application of fluoride varnish |
839 |
833 |
$8K |
| D1999 |
|
704 |
683 |
$905.00 |
| D1330 |
|
39 |
32 |
$0.00 |