| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,503 |
$99K |
| D1110 |
Prophylaxis - adult |
1,097 |
1,097 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
1,232 |
1,226 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,251 |
1,251 |
$60K |
| D1120 |
Prophylaxis - child |
1,186 |
1,179 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,459 |
2,447 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,150 |
1,144 |
$24K |
| D2140 |
|
329 |
92 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,174 |
1,814 |
$17K |
| D9430 |
|
333 |
328 |
$11K |
| D1351 |
Sealant - per tooth |
148 |
26 |
$6K |
| D0350 |
|
471 |
183 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
13 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$90.75 |