| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2791 |
|
664 |
436 |
$316K |
| D1110 |
Prophylaxis - adult |
3,040 |
3,023 |
$261K |
| D4341 |
|
3,296 |
903 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
3,075 |
3,061 |
$194K |
| D4910 |
|
1,288 |
1,288 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,595 |
818 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,799 |
2,568 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,137 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,217 |
1,213 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,203 |
4,185 |
$56K |
| D1120 |
Prophylaxis - child |
962 |
962 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,003 |
2,941 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
338 |
180 |
$19K |
| D9110 |
|
183 |
171 |
$11K |
| D2954 |
|
101 |
64 |
$11K |
| D2952 |
|
84 |
64 |
$9K |
| D2330 |
|
89 |
50 |
$7K |
| D4342 |
|
50 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
170 |
169 |
$2K |
| D1999 |
|
64 |
63 |
$0.00 |