| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,264 |
3,936 |
$165K |
| D2140 |
|
1,907 |
1,297 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,095 |
3,752 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,828 |
4,380 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,333 |
3,079 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,311 |
2,889 |
$78K |
| D1120 |
Prophylaxis - child |
2,415 |
2,226 |
$75K |
| D0330 |
Panoramic radiographic image |
1,878 |
1,712 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,410 |
2,205 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
468 |
374 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,605 |
1,553 |
$31K |
| D5110 |
|
36 |
26 |
$15K |
| D1351 |
Sealant - per tooth |
469 |
130 |
$13K |
| D0272 |
Bitewings - two radiographic images |
522 |
491 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
482 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
213 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
39 |
$5K |
| D4355 |
|
32 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
37 |
$429.02 |
| D1999 |
|
128 |
122 |
$0.00 |