| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,514 |
2,276 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
2,550 |
2,320 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,192 |
1,041 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,058 |
946 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,500 |
1,405 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
301 |
184 |
$40K |
| D1120 |
Prophylaxis - child |
735 |
692 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,782 |
1,591 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
445 |
399 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,400 |
1,198 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
54 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
649 |
554 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
27 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
52 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
53 |
53 |
$2K |
| D0601 |
|
391 |
361 |
$0.00 |
| D0602 |
|
584 |
534 |
$0.00 |