| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,197 |
5,164 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
7,128 |
7,074 |
$230K |
| D1120 |
Prophylaxis - child |
1,093 |
1,088 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
639 |
612 |
$27K |
| D1206 |
Topical application of fluoride varnish |
2,747 |
2,708 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
435 |
207 |
$22K |
| D9920 |
|
1,174 |
1,158 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,781 |
1,714 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
152 |
$13K |
| D0274 |
Bitewings - four radiographic images |
677 |
675 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
919 |
893 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
863 |
863 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
55 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
116 |
$3K |
| D0602 |
|
2,221 |
2,115 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$672.00 |
| D0603 |
|
54 |
52 |
$242.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$140.00 |
| D1330 |
|
27 |
27 |
$0.00 |