| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,719 |
8,649 |
$405K |
| D0120 |
Periodic oral evaluation - established patient |
8,224 |
8,166 |
$232K |
| D1206 |
Topical application of fluoride varnish |
9,882 |
9,800 |
$226K |
| D0274 |
Bitewings - four radiographic images |
6,635 |
6,589 |
$212K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,320 |
1,415 |
$173K |
| D0330 |
Panoramic radiographic image |
2,560 |
2,543 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,989 |
1,111 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,573 |
916 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
3,255 |
3,107 |
$105K |
| D2160 |
|
838 |
568 |
$90K |
| D1120 |
Prophylaxis - child |
2,674 |
2,650 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,576 |
2,558 |
$76K |
| D1351 |
Sealant - per tooth |
4,707 |
627 |
$68K |
| D2140 |
|
1,304 |
762 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,716 |
4,568 |
$64K |
| D2330 |
|
739 |
384 |
$54K |
| D2161 |
|
241 |
168 |
$37K |
| D2331 |
|
413 |
233 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
557 |
271 |
$34K |
| D2332 |
|
251 |
126 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,997 |
1,686 |
$28K |
| D2335 |
|
170 |
103 |
$23K |
| D0272 |
Bitewings - two radiographic images |
861 |
856 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
137 |
$16K |
| D1330 |
|
657 |
651 |
$13K |
| D0240 |
|
205 |
105 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
113 |
94 |
$2K |
| D4355 |
|
73 |
73 |
$46.87 |
| D9995 |
|
12 |
12 |
$0.00 |