| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,455 |
5,353 |
$261K |
| D0120 |
Periodic oral evaluation - established patient |
4,852 |
4,775 |
$103K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,384 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
623 |
608 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
949 |
942 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
667 |
639 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
144 |
66 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
462 |
$18K |
| D1120 |
Prophylaxis - child |
358 |
357 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
243 |
162 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
476 |
458 |
$6K |
| D2740 |
Crown - porcelain/ceramic |
19 |
12 |
$6K |
| D2160 |
|
54 |
41 |
$5K |
| D0180 |
|
128 |
126 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D1999 |
|
16 |
14 |
$0.00 |