| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,638 |
1,611 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,414 |
1,401 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
1,639 |
1,614 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,146 |
1,137 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
750 |
401 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
523 |
281 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,399 |
1,754 |
$31K |
| D1120 |
Prophylaxis - child |
568 |
565 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,086 |
1,072 |
$13K |
| D2160 |
|
106 |
72 |
$8K |
| D9430 |
|
131 |
131 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
202 |
$3K |
| D2140 |
|
50 |
27 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
149 |
$2K |
| D0350 |
|
142 |
58 |
$1K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$1K |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$478.50 |