| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,579 |
1,572 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,748 |
1,747 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
1,426 |
1,421 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,346 |
1,344 |
$64K |
| D4910 |
|
683 |
681 |
$52K |
| D1120 |
Prophylaxis - child |
1,137 |
1,132 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
611 |
264 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,936 |
2,925 |
$39K |
| D4341 |
|
296 |
78 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,531 |
1,314 |
$19K |
| D0274 |
Bitewings - four radiographic images |
843 |
836 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,210 |
1,199 |
$14K |
| D9430 |
|
308 |
295 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
26 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
62 |
$8K |
| D0350 |
|
437 |
192 |
$4K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$810.00 |