| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,637 |
1,568 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,644 |
2,474 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,980 |
2,790 |
$62K |
| D1120 |
Prophylaxis - child |
1,300 |
1,216 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,171 |
1,136 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
250 |
$35K |
| D0330 |
Panoramic radiographic image |
413 |
400 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,163 |
1,088 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
441 |
$16K |
| D2140 |
|
232 |
159 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
114 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
386 |
362 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
108 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
55 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,531 |
608 |
$11K |
| D2331 |
|
32 |
25 |
$3K |
| D9986 |
|
13 |
13 |
$0.00 |