| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,154 |
2,144 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
2,830 |
2,820 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
1,060 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,985 |
3,738 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
806 |
523 |
$54K |
| D1120 |
Prophylaxis - child |
1,412 |
1,411 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,361 |
2,352 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,701 |
3,687 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
807 |
806 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,354 |
$17K |
| D9430 |
|
352 |
328 |
$11K |
| D4910 |
|
145 |
145 |
$11K |
| D4341 |
|
124 |
38 |
$9K |
| D2140 |
|
68 |
41 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
101 |
101 |
$1K |
| D0350 |
|
19 |
14 |
$145.50 |
| D1999 |
|
337 |
305 |
$0.00 |