| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,564 |
8,125 |
$183K |
| D9920 |
|
4,370 |
3,684 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,963 |
2,525 |
$26K |
| D1206 |
Topical application of fluoride varnish |
2,366 |
1,998 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,490 |
1,245 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,954 |
1,715 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,327 |
2,061 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
313 |
298 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
56 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
167 |
152 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
28 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
54 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$696.15 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$467.28 |