| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,614 |
3,611 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
4,948 |
4,937 |
$280K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,040 |
5,664 |
$127K |
| D1120 |
Prophylaxis - child |
2,424 |
2,424 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,564 |
867 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,037 |
1,035 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,718 |
4,714 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,144 |
4,144 |
$54K |
| D4341 |
|
447 |
122 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
45 |
28 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,791 |
1,754 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
92 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
51 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
26 |
$3K |