| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,213 |
2,206 |
$125K |
| D1110 |
Prophylaxis - adult |
988 |
980 |
$83K |
| D1120 |
Prophylaxis - child |
1,409 |
1,406 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
644 |
367 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,722 |
2,707 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,628 |
2,186 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
407 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
1,099 |
$23K |
| D4910 |
|
253 |
251 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
354 |
$16K |
| D4341 |
|
130 |
42 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
328 |
$4K |
| D2140 |
|
57 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
176 |
176 |
$2K |
| D1320 |
|
130 |
130 |
$2K |
| D2160 |
|
14 |
13 |
$1K |
| D0350 |
|
17 |
15 |
$208.50 |