| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,081 |
1,033 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,226 |
1,172 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
893 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,533 |
1,455 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
462 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
247 |
144 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
152 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,245 |
1,160 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
77 |
$11K |
| D0274 |
Bitewings - four radiographic images |
468 |
443 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
230 |
221 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
117 |
$9K |
| D1120 |
Prophylaxis - child |
200 |
192 |
$7K |
| D2140 |
|
36 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
104 |
75 |
$711.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$141.50 |
| D1999 |
|
14 |
12 |
$98.00 |
| D1310 |
|
21 |
20 |
$10.00 |
| D1330 |
|
22 |
21 |
$10.00 |