| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,769 |
6,274 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
7,182 |
6,669 |
$194K |
| D2160 |
|
1,563 |
1,390 |
$116K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,998 |
1,754 |
$106K |
| D1206 |
Topical application of fluoride varnish |
3,731 |
3,452 |
$92K |
| D1110 |
Prophylaxis - adult |
1,491 |
1,413 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,032 |
2,785 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
501 |
419 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
543 |
391 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,416 |
2,168 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
962 |
801 |
$16K |
| D1351 |
Sealant - per tooth |
235 |
153 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
646 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,321 |
1,253 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
385 |
$6K |
| D0330 |
Panoramic radiographic image |
123 |
108 |
$2K |
| D2140 |
|
12 |
12 |
$509.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$60.80 |
| D1999 |
|
53 |
49 |
$0.00 |