| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,977 |
1,829 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,194 |
2,090 |
$51K |
| D1120 |
Prophylaxis - child |
1,054 |
1,024 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
806 |
$36K |
| D2160 |
|
381 |
231 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,059 |
998 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
551 |
528 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
364 |
214 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
493 |
476 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
46 |
$8K |
| D2332 |
|
30 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
134 |
$3K |
| D2140 |
|
48 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
63 |
$716.62 |