| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,590 |
4,536 |
$254K |
| D0274 |
Bitewings - four radiographic images |
5,007 |
4,955 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
5,156 |
5,111 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,946 |
1,936 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
896 |
522 |
$56K |
| D1120 |
Prophylaxis - child |
706 |
696 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
206 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,597 |
1,529 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
129 |
107 |
$10K |
| D2140 |
|
121 |
64 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
54 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
63 |
$3K |
| D2330 |
|
39 |
26 |
$2K |
| D9110 |
|
40 |
40 |
$2K |
| D2331 |
|
18 |
13 |
$2K |