| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,308 |
6,184 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
8,024 |
7,876 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,926 |
7,793 |
$161K |
| D1110 |
Prophylaxis - adult |
2,601 |
2,570 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,689 |
844 |
$107K |
| D2140 |
|
1,391 |
923 |
$86K |
| D0272 |
Bitewings - two radiographic images |
4,375 |
4,316 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
641 |
406 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,605 |
2,529 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,613 |
1,420 |
$15K |
| D1206 |
Topical application of fluoride varnish |
616 |
596 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
402 |
396 |
$10K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$342.72 |
| D1330 |
|
36 |
35 |
$0.00 |
| D1310 |
|
35 |
34 |
$0.00 |