| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,440 |
4,413 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
6,195 |
6,145 |
$182K |
| D0274 |
Bitewings - four radiographic images |
3,796 |
3,766 |
$129K |
| D1206 |
Topical application of fluoride varnish |
4,731 |
4,699 |
$113K |
| D0330 |
Panoramic radiographic image |
1,485 |
1,468 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,555 |
2,439 |
$80K |
| D1120 |
Prophylaxis - child |
2,259 |
2,240 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
763 |
445 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
750 |
504 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,385 |
1,377 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,254 |
1,237 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,713 |
2,630 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
310 |
$21K |
| D1351 |
Sealant - per tooth |
659 |
200 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
284 |
214 |
$15K |
| D2940 |
|
369 |
297 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
567 |
528 |
$6K |
| D2160 |
|
55 |
54 |
$4K |
| D2335 |
|
20 |
16 |
$3K |
| D2331 |
|
52 |
41 |
$2K |
| D2140 |
|
145 |
102 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
57 |
$679.40 |
| D9110 |
|
14 |
14 |
$626.08 |
| D9995 |
|
17 |
17 |
$0.00 |
| D1999 |
|
614 |
537 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$0.00 |