| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,544 |
1,468 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,777 |
1,594 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
526 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
524 |
336 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,496 |
1,414 |
$19K |
| D1120 |
Prophylaxis - child |
781 |
724 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,230 |
1,178 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
722 |
632 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
191 |
113 |
$15K |
| D0274 |
Bitewings - four radiographic images |
486 |
466 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
204 |
70 |
$7K |
| D9110 |
|
271 |
251 |
$7K |
| D0272 |
Bitewings - two radiographic images |
426 |
404 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
714 |
$6K |
| D2140 |
|
93 |
62 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
25 |
$1K |
| D2160 |
|
16 |
14 |
$870.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$81.62 |