| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,706 |
1,696 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
1,756 |
1,738 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
871 |
867 |
$51K |
| D4341 |
|
648 |
207 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,726 |
2,711 |
$35K |
| D2791 |
|
76 |
52 |
$35K |
| D9430 |
|
1,164 |
1,145 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
623 |
620 |
$26K |
| D1120 |
Prophylaxis - child |
675 |
672 |
$21K |
| D4910 |
|
215 |
213 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,377 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
66 |
$11K |
| D3320 |
|
27 |
25 |
$10K |
| D1320 |
|
523 |
523 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
40 |
$6K |
| D2954 |
|
62 |
37 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
672 |
604 |
$5K |
| D0350 |
|
159 |
120 |
$3K |
| D4342 |
|
29 |
12 |
$1K |
| D9993 |
|
28 |
28 |
$568.75 |
| D1310 |
|
27 |
27 |
$402.50 |
| D1330 |
|
13 |
13 |
$0.00 |