| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,695 |
1,693 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,720 |
1,717 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,253 |
734 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,270 |
1,269 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,829 |
1,827 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
439 |
252 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
372 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,319 |
1,420 |
$14K |
| D9430 |
|
375 |
356 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
171 |
171 |
$12K |
| D2330 |
|
113 |
72 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
493 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$748.14 |