| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,049 |
2,041 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
2,864 |
2,851 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
777 |
604 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,710 |
1,703 |
$72K |
| D1206 |
Topical application of fluoride varnish |
1,496 |
1,487 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
859 |
838 |
$35K |
| D1120 |
Prophylaxis - child |
794 |
789 |
$34K |
| D2140 |
|
324 |
240 |
$24K |
| D0330 |
Panoramic radiographic image |
266 |
265 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
63 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
694 |
676 |
$11K |
| D2330 |
|
115 |
78 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
182 |
$7K |
| D2331 |
|
44 |
39 |
$5K |
| D2160 |
|
18 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
58 |
56 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$1K |