| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,082 |
969 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,620 |
560 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
414 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
224 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
241 |
111 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,942 |
1,742 |
$10K |
| D1110 |
Prophylaxis - adult |
328 |
293 |
$5K |
| D0330 |
Panoramic radiographic image |
42 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,445 |
1,309 |
$2K |
| D2160 |
|
19 |
13 |
$1K |
| D2331 |
|
27 |
13 |
$1K |
| D2140 |
|
33 |
25 |
$892.44 |
| D1206 |
Topical application of fluoride varnish |
61 |
54 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
436 |
373 |
$0.00 |
| D1120 |
Prophylaxis - child |
70 |
65 |
$0.00 |