| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,692 |
1,684 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,411 |
1,405 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,387 |
1,385 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,121 |
516 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,338 |
1,878 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,449 |
2,438 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
394 |
391 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,414 |
1,350 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
243 |
180 |
$13K |
| D1120 |
Prophylaxis - child |
337 |
337 |
$13K |
| D0274 |
Bitewings - four radiographic images |
506 |
506 |
$11K |
| D9430 |
|
219 |
216 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |