| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
842 |
841 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,056 |
1,051 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,440 |
1,427 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
804 |
643 |
$53K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
99 |
94 |
$46K |
| D1120 |
Prophylaxis - child |
1,315 |
1,311 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,756 |
1,753 |
$36K |
| D2140 |
|
636 |
472 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,709 |
2,637 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,023 |
2,021 |
$21K |
| D9430 |
|
484 |
477 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
131 |
$14K |
| D0350 |
|
1,070 |
710 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
716 |
$9K |
| D0272 |
Bitewings - two radiographic images |
499 |
499 |
$6K |
| D3320 |
|
13 |
12 |
$5K |
| D2160 |
|
12 |
12 |
$957.60 |