| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12,960 |
11,831 |
$699K |
| D9920 |
|
8,761 |
7,640 |
$632K |
| D1206 |
Topical application of fluoride varnish |
13,099 |
11,939 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
7,368 |
6,414 |
$151K |
| D4341 |
|
1,088 |
330 |
$116K |
| D0274 |
Bitewings - four radiographic images |
1,619 |
1,579 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
627 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
398 |
268 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
371 |
179 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
497 |
474 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,357 |
1,113 |
$18K |
| D0180 |
|
692 |
486 |
$17K |
| D9248 |
|
284 |
275 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
193 |
$7K |
| D2331 |
|
56 |
38 |
$6K |
| D2140 |
|
67 |
50 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$3K |
| D2330 |
|
48 |
32 |
$3K |
| D2160 |
|
27 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
234 |
87 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
24 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$1K |
| D0190 |
|
22 |
22 |
$580.00 |