| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,368 |
4,261 |
$129K |
| D0330 |
Panoramic radiographic image |
3,478 |
3,387 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,276 |
5,184 |
$94K |
| D1110 |
Prophylaxis - adult |
2,411 |
2,348 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,448 |
4,343 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,859 |
3,757 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,447 |
704 |
$85K |
| D2140 |
|
1,148 |
609 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,983 |
1,935 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,886 |
1,861 |
$29K |
| D1351 |
Sealant - per tooth |
1,188 |
220 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
63 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
13 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
350 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
607 |
553 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
88 |
80 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$1K |
| D9430 |
|
78 |
70 |
$0.00 |