| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
957 |
679 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,224 |
918 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
929 |
697 |
$14K |
| D0274 |
Bitewings - four radiographic images |
617 |
463 |
$13K |
| D2394 |
|
150 |
40 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
152 |
$7K |
| D1120 |
Prophylaxis - child |
334 |
257 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
39 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
14 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
115 |
$829.50 |