| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,854 |
2,786 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
2,808 |
2,719 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
866 |
291 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
670 |
641 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,612 |
1,585 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
374 |
240 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
816 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,381 |
1,338 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,027 |
982 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
487 |
$16K |
| D0330 |
Panoramic radiographic image |
569 |
561 |
$15K |
| D1206 |
Topical application of fluoride varnish |
721 |
715 |
$14K |
| D0274 |
Bitewings - four radiographic images |
785 |
777 |
$12K |
| D2160 |
|
119 |
81 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
407 |
$7K |
| D2140 |
|
44 |
32 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
24 |
$2K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
16 |
$1K |
| D0603 |
|
15 |
15 |
$75.00 |
| D0602 |
|
15 |
14 |
$65.00 |