| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,051 |
2,671 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,097 |
2,789 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
984 |
841 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,528 |
1,356 |
$47K |
| D5110 |
|
76 |
72 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,200 |
1,046 |
$37K |
| D0274 |
Bitewings - four radiographic images |
783 |
693 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,052 |
941 |
$18K |
| D1120 |
Prophylaxis - child |
399 |
328 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
808 |
734 |
$8K |
| D5120 |
|
12 |
12 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
32 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
25 |
$3K |
| D2331 |
|
19 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
15 |
$1K |
| D1206 |
Topical application of fluoride varnish |
74 |
69 |
$667.50 |
| D5765 |
|
16 |
12 |
$592.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
14 |
$210.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
14 |
$0.00 |