| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,187 |
2,180 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
3,255 |
3,239 |
$153K |
| D4341 |
|
978 |
393 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,844 |
3,404 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
787 |
596 |
$48K |
| D1120 |
Prophylaxis - child |
1,311 |
1,310 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
611 |
396 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,953 |
2,942 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
541 |
$31K |
| D2140 |
|
410 |
294 |
$21K |
| D0350 |
|
1,886 |
1,287 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,337 |
1,336 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
792 |
789 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,167 |
1,074 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
60 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$3K |
| D2330 |
|
21 |
15 |
$2K |