| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,989 |
5,970 |
$221K |
| D4341 |
|
4,622 |
1,253 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
7,127 |
7,104 |
$138K |
| D0274 |
Bitewings - four radiographic images |
6,734 |
6,722 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
6,954 |
6,941 |
$64K |
| D9995 |
|
2,165 |
2,115 |
$48K |
| D1120 |
Prophylaxis - child |
765 |
763 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,725 |
3,718 |
$17K |
| D2140 |
|
490 |
123 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,441 |
1,438 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
137 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
202 |
72 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$790.28 |
| D9110 |
|
12 |
12 |
$203.35 |