| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,395 |
4,373 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
4,404 |
4,378 |
$241K |
| D4341 |
|
2,461 |
670 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,360 |
2,347 |
$147K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,528 |
6,598 |
$143K |
| D9430 |
|
3,287 |
3,040 |
$100K |
| D0274 |
Bitewings - four radiographic images |
4,719 |
4,692 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,741 |
6,700 |
$88K |
| D1120 |
Prophylaxis - child |
2,152 |
2,141 |
$81K |
| D4910 |
|
792 |
784 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
338 |
194 |
$39K |
| D4342 |
|
156 |
41 |
$7K |
| D1351 |
Sealant - per tooth |
250 |
43 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
15 |
$1K |
| D2920 |
|
21 |
13 |
$882.00 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
43 |
$470.00 |