| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,441 |
6,418 |
$349K |
| D1110 |
Prophylaxis - adult |
3,154 |
3,146 |
$266K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,626 |
1,442 |
$206K |
| D1120 |
Prophylaxis - child |
4,764 |
4,745 |
$178K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,352 |
1,767 |
$157K |
| D2160 |
|
1,926 |
1,390 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,801 |
6,819 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,164 |
2,162 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,782 |
2,774 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,025 |
7,997 |
$98K |
| D0350 |
|
9,831 |
3,440 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,418 |
3,406 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,975 |
$23K |
| D9430 |
|
684 |
677 |
$21K |
| D2161 |
|
228 |
191 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,178 |
1,177 |
$14K |
| D2140 |
|
116 |
91 |
$6K |
| D4341 |
|
30 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D9993 |
|
26 |
26 |
$2K |
| D1310 |
|
26 |
26 |
$1K |