| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,475 |
2,429 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,648 |
3,598 |
$91K |
| D1120 |
Prophylaxis - child |
1,351 |
1,334 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,969 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
911 |
867 |
$32K |
| D0274 |
Bitewings - four radiographic images |
931 |
913 |
$29K |
| D0330 |
Panoramic radiographic image |
546 |
535 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
86 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
163 |
159 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
44 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
39 |
$6K |
| D0272 |
Bitewings - two radiographic images |
319 |
314 |
$6K |
| D2330 |
|
78 |
36 |
$5K |
| D1206 |
Topical application of fluoride varnish |
218 |
217 |
$4K |
| D2140 |
|
34 |
17 |
$2K |
| D1354 |
|
329 |
105 |
$2K |
| D1351 |
Sealant - per tooth |
77 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
36 |
$529.60 |