| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,075 |
2,071 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,313 |
2,309 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
2,025 |
2,018 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,460 |
3,424 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,304 |
639 |
$73K |
| D9430 |
|
1,554 |
1,541 |
$49K |
| D1120 |
Prophylaxis - child |
1,230 |
1,229 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,513 |
3,509 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,047 |
3,044 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,722 |
2,640 |
$32K |
| D0274 |
Bitewings - four radiographic images |
686 |
686 |
$15K |
| D2330 |
|
48 |
38 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
13 |
$940.80 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$709.80 |