| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,405 |
2,395 |
$125K |
| D9430 |
|
3,049 |
2,760 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,524 |
1,520 |
$96K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
745 |
323 |
$87K |
| D1120 |
Prophylaxis - child |
1,987 |
1,982 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,458 |
1,452 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,429 |
4,491 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
2,423 |
2,231 |
$28K |
| D1110 |
Prophylaxis - adult |
312 |
312 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,229 |
2,226 |
$23K |
| D4910 |
|
281 |
281 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,419 |
1,415 |
$16K |
| D0274 |
Bitewings - four radiographic images |
492 |
490 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
76 |
$10K |
| D1320 |
|
625 |
622 |
$9K |
| D1206 |
Topical application of fluoride varnish |
495 |
490 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$7K |
| D4341 |
|
88 |
26 |
$6K |
| D2160 |
|
63 |
38 |
$5K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |