| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,183 |
2,075 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,137 |
2,970 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,841 |
1,561 |
$62K |
| D4355 |
|
720 |
680 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,425 |
1,343 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,352 |
2,215 |
$37K |
| D1120 |
Prophylaxis - child |
1,136 |
1,067 |
$29K |
| D0330 |
Panoramic radiographic image |
490 |
460 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
192 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,274 |
1,081 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
108 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
225 |
$9K |
| D0272 |
Bitewings - two radiographic images |
364 |
347 |
$6K |
| D1351 |
Sealant - per tooth |
209 |
59 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
38 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
187 |
$3K |
| D2332 |
|
24 |
13 |
$2K |
| D2335 |
|
17 |
12 |
$2K |
| D9110 |
|
18 |
17 |
$673.99 |