| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,059 |
1,041 |
$26K |
| D1110 |
Prophylaxis - adult |
565 |
550 |
$16K |
| D1120 |
Prophylaxis - child |
736 |
726 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
292 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
727 |
717 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
106 |
$9K |
| D2140 |
|
154 |
107 |
$6K |
| D1351 |
Sealant - per tooth |
290 |
80 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
115 |
$5K |
| D0274 |
Bitewings - four radiographic images |
134 |
132 |
$3K |
| D0272 |
Bitewings - two radiographic images |
86 |
86 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$969.00 |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
86 |
$900.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$128.00 |