| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,907 |
3,825 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,768 |
5,651 |
$174K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,497 |
976 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,813 |
2,746 |
$109K |
| D1120 |
Prophylaxis - child |
2,050 |
2,018 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
230 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
632 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
901 |
885 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,112 |
1,056 |
$15K |
| D1206 |
Topical application of fluoride varnish |
506 |
502 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
58 |
$10K |
| D2140 |
|
193 |
142 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
306 |
$6K |
| D0272 |
Bitewings - two radiographic images |
114 |
109 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$2K |
| D2330 |
|
22 |
12 |
$2K |