| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,257 |
5,252 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
6,648 |
6,636 |
$179K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,484 |
1,223 |
$156K |
| D0274 |
Bitewings - four radiographic images |
3,661 |
3,660 |
$96K |
| D0330 |
Panoramic radiographic image |
1,460 |
1,459 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,672 |
1,665 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
460 |
314 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
435 |
332 |
$33K |
| D2160 |
|
197 |
179 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,759 |
1,723 |
$22K |
| D1120 |
Prophylaxis - child |
389 |
389 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
509 |
509 |
$15K |
| D2331 |
|
96 |
75 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
111 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
351 |
351 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
295 |
$4K |
| D2140 |
|
55 |
52 |
$4K |
| D4910 |
|
27 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
38 |
$368.97 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.16 |
| D1999 |
|
917 |
849 |
$0.00 |