| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,189 |
5,970 |
$231K |
| D1206 |
Topical application of fluoride varnish |
6,435 |
6,205 |
$218K |
| D0330 |
Panoramic radiographic image |
4,023 |
3,885 |
$204K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,860 |
1,145 |
$187K |
| D1120 |
Prophylaxis - child |
4,130 |
4,000 |
$173K |
| D0140 |
Limited oral evaluation - problem focused |
4,894 |
4,536 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
6,130 |
5,941 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,407 |
4,302 |
$100K |
| D1351 |
Sealant - per tooth |
4,249 |
996 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
879 |
603 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,430 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
840 |
402 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,134 |
3,819 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,604 |
2,548 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
843 |
546 |
$45K |
| D7250 |
|
102 |
56 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,321 |
1,157 |
$14K |
| D9920 |
|
307 |
280 |
$10K |
| D1310 |
|
415 |
394 |
$9K |
| D1330 |
|
413 |
392 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
186 |
$7K |
| D0272 |
Bitewings - two radiographic images |
405 |
389 |
$7K |
| D2140 |
|
75 |
45 |
$2K |
| D2950 |
|
18 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
34 |
$1K |
| D2335 |
|
17 |
15 |
$1K |
| D2330 |
|
24 |
12 |
$665.00 |
| D9992 |
|
46 |
22 |
$594.00 |
| D0603 |
|
347 |
333 |
$0.01 |
| D1999 |
|
26 |
26 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |