| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,025 |
1,024 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,284 |
1,282 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
861 |
861 |
$53K |
| D1120 |
Prophylaxis - child |
702 |
701 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,910 |
1,907 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,327 |
1,326 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,012 |
1,995 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
66 |
$6K |
| D2160 |
|
34 |
25 |
$3K |
| D9430 |
|
55 |
54 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
65 |
$747.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$672.00 |