| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,190 |
3,143 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
3,284 |
3,234 |
$74K |
| D0274 |
Bitewings - four radiographic images |
891 |
878 |
$32K |
| D9450 |
|
1,754 |
1,553 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
338 |
256 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,009 |
1,004 |
$26K |
| D1120 |
Prophylaxis - child |
532 |
526 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
96 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
437 |
$7K |
| D9110 |
|
103 |
97 |
$4K |
| D2140 |
|
54 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
112 |
112 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$2K |
| D2331 |
|
13 |
12 |
$1K |
| D2160 |
|
12 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$840.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$517.00 |