| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,495 |
1,493 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,456 |
1,452 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,362 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,377 |
1,373 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,675 |
2,671 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,862 |
1,299 |
$24K |
| D4910 |
|
313 |
310 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
195 |
$22K |
| D1120 |
Prophylaxis - child |
585 |
584 |
$20K |
| D0330 |
Panoramic radiographic image |
657 |
655 |
$19K |
| D0350 |
|
1,531 |
536 |
$16K |
| D9430 |
|
308 |
303 |
$10K |
| D0274 |
Bitewings - four radiographic images |
402 |
400 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
59 |
$6K |
| D4341 |
|
58 |
17 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
268 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
143 |
143 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$975.80 |
| D1999 |
|
83 |
75 |
$45.00 |