| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,631 |
1,514 |
$451K |
| D0220 |
Intraoral - periapical first radiographic image |
1,486 |
1,421 |
$432K |
| D1110 |
Prophylaxis - adult |
716 |
707 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
556 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
389 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
151 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
415 |
410 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
103 |
$37K |
| D1206 |
Topical application of fluoride varnish |
120 |
116 |
$15K |
| D2140 |
|
40 |
26 |
$12K |
| D2160 |
|
17 |
13 |
$6K |
| D0274 |
Bitewings - four radiographic images |
100 |
100 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
111 |
$654.00 |
| D0270 |
|
14 |
12 |
$455.00 |