| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,121 |
4,086 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
6,063 |
6,015 |
$197K |
| D1206 |
Topical application of fluoride varnish |
5,985 |
5,933 |
$156K |
| D0274 |
Bitewings - four radiographic images |
3,425 |
3,392 |
$119K |
| D1120 |
Prophylaxis - child |
3,156 |
3,132 |
$108K |
| D0330 |
Panoramic radiographic image |
1,757 |
1,732 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,606 |
2,481 |
$90K |
| D1351 |
Sealant - per tooth |
2,677 |
704 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
816 |
528 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,721 |
1,702 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,700 |
1,685 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
414 |
248 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,255 |
2,178 |
$29K |
| D2140 |
|
362 |
233 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
108 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
611 |
568 |
$10K |
| D2160 |
|
82 |
63 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
68 |
$7K |
| D2940 |
|
68 |
53 |
$3K |
| D2331 |
|
19 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
96 |
$1K |
| D0160 |
|
13 |
13 |
$725.66 |
| D9110 |
|
13 |
12 |
$583.70 |
| D0270 |
|
26 |
26 |
$395.74 |
| D1999 |
|
670 |
589 |
$0.00 |
| D9995 |
|
31 |
31 |
$0.00 |