| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,538 |
1,527 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,740 |
1,732 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
1,219 |
1,209 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,585 |
1,577 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,643 |
2,528 |
$44K |
| D9430 |
|
1,274 |
1,229 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,415 |
2,401 |
$34K |
| D1120 |
Prophylaxis - child |
698 |
695 |
$31K |
| D0350 |
|
3,180 |
1,128 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,683 |
1,620 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
167 |
78 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,125 |
1,115 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
166 |
118 |
$11K |
| D1320 |
|
751 |
749 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$2K |
| D4910 |
|
13 |
13 |
$1K |