| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,736 |
2,727 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,472 |
1,151 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
740 |
740 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,383 |
2,285 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
187 |
$14K |
| D4346 |
|
45 |
45 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,636 |
1,632 |
$7K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$2K |
| D2160 |
|
13 |
12 |
$2K |
| D2140 |
|
54 |
43 |
$1K |
| D9110 |
|
20 |
18 |
$978.06 |
| D2940 |
|
13 |
12 |
$820.23 |
| D0274 |
Bitewings - four radiographic images |
1,300 |
1,298 |
$780.72 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,810 |
2,804 |
$526.46 |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
1,109 |
$389.71 |
| D0220 |
Intraoral - periapical first radiographic image |
3,080 |
2,968 |
$248.27 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
16 |
15 |
$130.72 |
| D1999 |
|
28 |
27 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
409 |
272 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$0.00 |