| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2791 |
|
360 |
281 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
1,510 |
1,494 |
$103K |
| D1120 |
Prophylaxis - child |
1,250 |
1,238 |
$64K |
| D4341 |
|
897 |
242 |
$62K |
| D2952 |
|
480 |
375 |
$50K |
| D4910 |
|
562 |
556 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
651 |
518 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
652 |
$43K |
| D9110 |
|
586 |
561 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,647 |
1,633 |
$26K |
| D1110 |
Prophylaxis - adult |
287 |
286 |
$25K |
| D9430 |
|
777 |
771 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,862 |
1,850 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,275 |
901 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
157 |
79 |
$19K |
| D2140 |
|
153 |
126 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
652 |
637 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$6K |
| D0350 |
|
290 |
268 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
14 |
$2K |