| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,479 |
2,417 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,970 |
1,936 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,047 |
997 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
196 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
541 |
151 |
$33K |
| D4355 |
|
285 |
273 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
497 |
483 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
910 |
876 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
864 |
602 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
37 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
52 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
137 |
$9K |
| D0170 |
|
298 |
257 |
$8K |
| D0274 |
Bitewings - four radiographic images |
257 |
245 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
114 |
$2K |
| D1120 |
Prophylaxis - child |
15 |
14 |
$418.32 |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$284.48 |
| D1206 |
Topical application of fluoride varnish |
18 |
14 |
$246.54 |