| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,255 |
2,228 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
2,411 |
2,391 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
621 |
606 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
814 |
811 |
$24K |
| D0274 |
Bitewings - four radiographic images |
630 |
627 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,084 |
1,040 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
399 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
36 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
63 |
$8K |
| D2140 |
|
44 |
25 |
$3K |
| D9110 |
|
71 |
69 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
127 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$612.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$344.00 |
| D1999 |
|
79 |
68 |
$0.00 |