| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,772 |
2,762 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
3,868 |
3,845 |
$174K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,281 |
965 |
$85K |
| D1120 |
Prophylaxis - child |
2,097 |
2,089 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
1,153 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,691 |
5,022 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
942 |
609 |
$54K |
| D2330 |
|
637 |
391 |
$48K |
| D2140 |
|
854 |
607 |
$46K |
| D4341 |
|
623 |
276 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,860 |
2,723 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,552 |
1,539 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
562 |
562 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,832 |
1,820 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
387 |
208 |
$21K |
| D9110 |
|
163 |
148 |
$10K |
| D2331 |
|
17 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
16 |
$1K |
| D2160 |
|
14 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
37 |
$306.00 |