| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,789 |
1,780 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
2,156 |
2,146 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,648 |
1,639 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,848 |
1,109 |
$102K |
| D9430 |
|
1,468 |
1,463 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,008 |
1,002 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,596 |
2,577 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
450 |
179 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,531 |
1,320 |
$18K |
| D1120 |
Prophylaxis - child |
394 |
394 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,104 |
1,095 |
$13K |
| D2330 |
|
98 |
41 |
$8K |
| D0330 |
Panoramic radiographic image |
263 |
263 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
36 |
$4K |
| D0274 |
Bitewings - four radiographic images |
155 |
154 |
$3K |
| D0350 |
|
69 |
68 |
$259.20 |
| D1330 |
|
21 |
21 |
$0.00 |