| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,181 |
1,172 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,783 |
1,919 |
$40K |
| D1120 |
Prophylaxis - child |
708 |
694 |
$22K |
| D0274 |
Bitewings - four radiographic images |
980 |
974 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,102 |
1,086 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
128 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
24 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
37 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
15 |
$2K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$312.00 |