| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,998 |
1,983 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
2,631 |
2,613 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
1,675 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,026 |
1,016 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
792 |
519 |
$44K |
| D9430 |
|
1,342 |
1,288 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,579 |
2,564 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,449 |
2,210 |
$29K |
| D4341 |
|
411 |
111 |
$29K |
| D0272 |
Bitewings - two radiographic images |
569 |
564 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D1120 |
Prophylaxis - child |
209 |
209 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,352 |
896 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
63 |
$5K |
| D2330 |
|
61 |
38 |
$4K |
| D2140 |
|
82 |
53 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
25 |
$2K |
| D1999 |
|
14 |
14 |
$0.00 |