| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,163 |
1,968 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,768 |
2,515 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,371 |
1,237 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,230 |
1,123 |
$42K |
| D1120 |
Prophylaxis - child |
1,169 |
1,094 |
$33K |
| D1206 |
Topical application of fluoride varnish |
969 |
863 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
447 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
201 |
116 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
531 |
514 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
590 |
523 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
53 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
71 |
59 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
39 |
$990.78 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$506.35 |
| D1999 |
|
61 |
57 |
$0.00 |