| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,363 |
4,312 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
723 |
301 |
$76K |
| D4910 |
|
1,061 |
1,051 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,369 |
2,344 |
$64K |
| D1110 |
Prophylaxis - adult |
1,333 |
1,315 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,448 |
1,433 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,315 |
1,283 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
892 |
883 |
$40K |
| D4341 |
|
422 |
201 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,578 |
2,507 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
229 |
$27K |
| D0274 |
Bitewings - four radiographic images |
998 |
982 |
$25K |
| D4342 |
|
368 |
156 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
330 |
181 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,791 |
1,309 |
$14K |
| D1120 |
Prophylaxis - child |
347 |
338 |
$13K |
| D0603 |
|
907 |
900 |
$8K |
| D9630 |
|
419 |
379 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
61 |
$5K |
| D0602 |
|
383 |
382 |
$3K |
| D1999 |
|
556 |
447 |
$3K |
| D0270 |
|
212 |
209 |
$2K |
| D2331 |
|
21 |
14 |
$1K |
| D2140 |
|
15 |
13 |
$676.00 |