| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,046 |
3,023 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,515 |
4,491 |
$122K |
| D4910 |
|
1,090 |
1,080 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,957 |
1,938 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
939 |
930 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,363 |
1,332 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,059 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,912 |
1,903 |
$35K |
| D1120 |
Prophylaxis - child |
763 |
762 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
3,594 |
3,449 |
$30K |
| D4341 |
|
294 |
123 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,654 |
2,576 |
$17K |
| D1206 |
Topical application of fluoride varnish |
867 |
856 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
104 |
$16K |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$918.00 |
| D1999 |
|
1,032 |
862 |
$0.00 |
| D4921 |
|
349 |
109 |
$0.00 |