| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,055 |
1,970 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,904 |
2,778 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,692 |
2,577 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,066 |
1,049 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
931 |
893 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,172 |
1,113 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
79 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,351 |
517 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,518 |
3,457 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
4,921 |
4,627 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
72 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
33 |
$582.12 |
| D1999 |
|
2,310 |
2,017 |
$0.00 |