| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,126 |
3,098 |
$269K |
| D4341 |
|
4,034 |
1,072 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
4,328 |
4,300 |
$237K |
| D4910 |
|
2,045 |
2,031 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,518 |
4,091 |
$124K |
| D1120 |
Prophylaxis - child |
2,080 |
2,070 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,065 |
1,056 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,022 |
4,982 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
959 |
693 |
$55K |
| D0272 |
Bitewings - two radiographic images |
4,061 |
4,040 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
679 |
428 |
$45K |
| D2140 |
|
317 |
187 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
25 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
321 |
$15K |
| D1206 |
Topical application of fluoride varnish |
693 |
693 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
808 |
$10K |
| D1351 |
Sealant - per tooth |
325 |
85 |
$10K |
| D0350 |
|
221 |
111 |
$2K |