| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,380 |
2,357 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,149 |
3,108 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
4,572 |
4,514 |
$129K |
| D1120 |
Prophylaxis - child |
4,714 |
4,642 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,129 |
7,029 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
8,504 |
8,225 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,463 |
699 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,441 |
7,422 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,163 |
772 |
$53K |
| D2140 |
|
1,102 |
762 |
$48K |
| D9430 |
|
1,709 |
1,659 |
$44K |
| D0272 |
Bitewings - two radiographic images |
5,489 |
5,412 |
$44K |
| D4341 |
|
548 |
179 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
833 |
833 |
$37K |
| D9999 |
Unspecified adjunctive procedure, by report |
310 |
273 |
$30K |
| D1351 |
Sealant - per tooth |
403 |
102 |
$11K |
| D1320 |
|
1,094 |
1,094 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
41 |
$5K |
| D0350 |
|
861 |
390 |
$4K |
| D1999 |
|
57 |
57 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
57 |
57 |
$3K |
| D4910 |
|
44 |
44 |
$3K |
| D2160 |
|
53 |
43 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D9110 |
|
12 |
12 |
$192.00 |
| D9986 |
|
15 |
15 |
$0.00 |
| D1330 |
|
1,451 |
1,439 |
$0.00 |