| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,755 |
1,677 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
712 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
842 |
424 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
339 |
$40K |
| D2140 |
|
377 |
225 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,364 |
2,123 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,587 |
1,518 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
42 |
$5K |
| D1110 |
Prophylaxis - adult |
928 |
885 |
$5K |
| D2160 |
|
80 |
49 |
$4K |
| D1120 |
Prophylaxis - child |
1,107 |
1,063 |
$4K |
| D1206 |
Topical application of fluoride varnish |
965 |
930 |
$4K |
| D0330 |
Panoramic radiographic image |
323 |
309 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
483 |
462 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
12 |
$865.51 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,232 |
1,358 |
$702.21 |