| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,319 |
2,311 |
$46K |
| D1110 |
Prophylaxis - adult |
1,267 |
1,260 |
$45K |
| D4355 |
|
829 |
825 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
697 |
692 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
649 |
311 |
$29K |
| D1120 |
Prophylaxis - child |
449 |
449 |
$18K |
| D0274 |
Bitewings - four radiographic images |
673 |
668 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,229 |
1,219 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
508 |
508 |
$12K |
| D2161 |
|
153 |
110 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
69 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,387 |
1,111 |
$8K |
| D2160 |
|
75 |
43 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
204 |
$5K |
| D2335 |
|
36 |
15 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$243.70 |