| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,533 |
3,411 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
737 |
426 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,503 |
2,461 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
3,340 |
3,222 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,139 |
1,033 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,617 |
1,566 |
$24K |
| D1120 |
Prophylaxis - child |
425 |
374 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,317 |
1,250 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
622 |
590 |
$14K |
| D0274 |
Bitewings - four radiographic images |
359 |
333 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
774 |
727 |
$8K |
| D1330 |
|
158 |
132 |
$3K |
| D2940 |
|
82 |
64 |
$2K |
| D1310 |
|
80 |
73 |
$2K |
| D9110 |
|
30 |
29 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$535.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$490.00 |
| D0602 |
|
1,931 |
1,899 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
224 |
204 |
$0.00 |
| D1999 |
|
252 |
230 |
$0.00 |