| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,714 |
1,711 |
$92K |
| D1110 |
Prophylaxis - adult |
1,013 |
1,008 |
$85K |
| D1120 |
Prophylaxis - child |
912 |
907 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
489 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,176 |
1,174 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
182 |
100 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
878 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
802 |
799 |
$7K |
| D9110 |
|
105 |
103 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
742 |
250 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |