| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,255 |
1,251 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,335 |
1,975 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,687 |
1,685 |
$33K |
| D1120 |
Prophylaxis - child |
922 |
922 |
$32K |
| D1110 |
Prophylaxis - adult |
354 |
352 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
336 |
147 |
$22K |
| D2140 |
|
198 |
82 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
801 |
801 |
$8K |
| D1206 |
Topical application of fluoride varnish |
486 |
483 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
115 |
$7K |
| D0350 |
|
214 |
142 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$130.00 |