| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,674 |
2,633 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,266 |
4,189 |
$114K |
| D1110 |
Prophylaxis - adult |
2,047 |
2,020 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,651 |
846 |
$86K |
| D1120 |
Prophylaxis - child |
878 |
858 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
289 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,938 |
1,902 |
$30K |
| D2332 |
|
141 |
90 |
$10K |
| D2335 |
|
54 |
36 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
39 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
85 |
81 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$990.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$748.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$134.00 |