| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,844 |
1,830 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,098 |
2,083 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,002 |
1,002 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,734 |
2,353 |
$33K |
| D1999 |
|
2,897 |
2,651 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,308 |
1,300 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
921 |
921 |
$21K |
| D1120 |
Prophylaxis - child |
662 |
661 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
305 |
183 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,899 |
2,848 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
112 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
708 |
706 |
$16K |
| D1206 |
Topical application of fluoride varnish |
667 |
624 |
$15K |
| D2140 |
|
53 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
121 |
121 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$962.88 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$594.00 |