| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,792 |
1,783 |
$107K |
| D1110 |
Prophylaxis - adult |
1,005 |
999 |
$85K |
| D1120 |
Prophylaxis - child |
1,615 |
1,614 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,011 |
1,007 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,109 |
1,104 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,028 |
3,016 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
614 |
321 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,278 |
2,349 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,565 |
1,557 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
216 |
118 |
$15K |
| D2140 |
|
234 |
110 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
820 |
760 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
26 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D9430 |
|
14 |
13 |
$448.00 |
| D0350 |
|
29 |
16 |
$156.00 |