| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,459 |
1,458 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,729 |
1,713 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,482 |
1,467 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,349 |
1,347 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
469 |
263 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,426 |
2,221 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,469 |
2,463 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,322 |
1,321 |
$28K |
| D1120 |
Prophylaxis - child |
757 |
751 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
203 |
$21K |
| D4910 |
|
243 |
243 |
$19K |
| D4341 |
|
259 |
73 |
$18K |
| D9430 |
|
584 |
561 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
888 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
49 |
$4K |
| D0350 |
|
430 |
241 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |