| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,216 |
1,172 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
563 |
537 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,271 |
1,240 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
957 |
831 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
966 |
940 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
456 |
431 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
726 |
$9K |
| D1120 |
Prophylaxis - child |
113 |
109 |
$5K |
| D9944 |
|
14 |
14 |
$4K |
| D0274 |
Bitewings - four radiographic images |
131 |
125 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
230 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$1K |