| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,993 |
6,984 |
$612K |
| D0120 |
Periodic oral evaluation - established patient |
5,821 |
5,813 |
$403K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,406 |
7,347 |
$232K |
| D1206 |
Topical application of fluoride varnish |
7,025 |
7,014 |
$121K |
| D4910 |
|
1,552 |
1,548 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,907 |
1,901 |
$113K |
| D9920 |
|
812 |
811 |
$110K |
| D2330 |
|
1,327 |
939 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
8,147 |
8,054 |
$97K |
| D4341 |
|
731 |
230 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
594 |
488 |
$39K |
| D9430 |
|
1,168 |
1,157 |
$37K |
| D9610 |
|
296 |
291 |
$22K |
| D9241 |
|
325 |
320 |
$19K |
| D9242 |
|
450 |
314 |
$18K |
| D2140 |
|
314 |
235 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
50 |
$6K |
| D1320 |
|
178 |
178 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$2K |
| D2931 |
|
15 |
13 |
$2K |
| D9410 |
|
56 |
56 |
$2K |
| D9243 |
|
31 |
13 |
$1K |
| D9239 |
|
13 |
13 |
$383.50 |