| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,048 |
4,908 |
$187K |
| D1120 |
Prophylaxis - child |
4,389 |
4,292 |
$143K |
| D1110 |
Prophylaxis - adult |
1,646 |
1,600 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,067 |
3,986 |
$102K |
| D1351 |
Sealant - per tooth |
2,508 |
568 |
$84K |
| D9999 |
Unspecified adjunctive procedure, by report |
696 |
642 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,225 |
906 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,052 |
1,042 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,165 |
1,145 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,400 |
3,274 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,632 |
2,695 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
287 |
$21K |
| D0274 |
Bitewings - four radiographic images |
2,027 |
1,977 |
$18K |
| D2140 |
|
505 |
411 |
$18K |
| D0272 |
Bitewings - two radiographic images |
953 |
928 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
36 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
64 |
64 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
127 |
$3K |
| D9110 |
|
26 |
25 |
$1K |
| D1999 |
|
12 |
12 |
$720.00 |
| D0602 |
|
414 |
267 |
$301.00 |
| D0601 |
|
350 |
301 |
$223.00 |
| D9986 |
|
109 |
109 |
$0.00 |