| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,553 |
9,549 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
11,219 |
11,219 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,806 |
8,800 |
$130K |
| D0274 |
Bitewings - four radiographic images |
8,842 |
8,841 |
$124K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,895 |
2,851 |
$117K |
| D2161 |
|
1,536 |
1,391 |
$77K |
| D2160 |
|
1,794 |
1,585 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
8,897 |
8,842 |
$44K |
| D1120 |
Prophylaxis - child |
1,627 |
1,627 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,232 |
2,231 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,793 |
2,793 |
$28K |
| D9110 |
|
2,718 |
2,683 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
81 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
713 |
$11K |
| D2140 |
|
531 |
464 |
$11K |
| D2951 |
|
449 |
424 |
$9K |
| D0270 |
|
1,656 |
1,649 |
$8K |
| D2331 |
|
176 |
135 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$630.00 |
| D3120 |
|
14 |
12 |
$0.00 |