| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,140 |
2,137 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,106 |
3,098 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
196 |
137 |
$17K |
| D0330 |
Panoramic radiographic image |
433 |
432 |
$15K |
| D0274 |
Bitewings - four radiographic images |
526 |
523 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
76 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
99 |
$5K |
| D2140 |
|
40 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
65 |
$805.02 |
| D1999 |
|
24 |
23 |
$0.00 |