| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,767 |
1,757 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,965 |
1,946 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,509 |
1,479 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
597 |
356 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,058 |
1,050 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
358 |
137 |
$28K |
| D1999 |
|
3,010 |
2,781 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,021 |
1,018 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,434 |
1,425 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,131 |
1,084 |
$8K |
| D1120 |
Prophylaxis - child |
190 |
190 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
29 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |