| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,277 |
2,263 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
2,663 |
2,653 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,592 |
1,043 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
862 |
856 |
$53K |
| D1120 |
Prophylaxis - child |
1,310 |
1,307 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,480 |
2,307 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,408 |
2,395 |
$28K |
| D0274 |
Bitewings - four radiographic images |
827 |
826 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
163 |
123 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,071 |
1,069 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
108 |
$5K |
| D9430 |
|
132 |
128 |
$4K |
| D2140 |
|
59 |
39 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
614 |
412 |
$2K |
| D2160 |
|
19 |
16 |
$1K |