| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,111 |
7,096 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
8,895 |
8,878 |
$181K |
| D0274 |
Bitewings - four radiographic images |
7,484 |
7,471 |
$138K |
| D2160 |
|
2,019 |
1,840 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,180 |
1,878 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
8,928 |
8,751 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,420 |
8,252 |
$51K |
| D1120 |
Prophylaxis - child |
1,530 |
1,529 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,561 |
3,560 |
$38K |
| D1351 |
Sealant - per tooth |
552 |
188 |
$20K |
| D9110 |
|
1,043 |
1,040 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
887 |
855 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
27 |
$1K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$1K |
| D2920 |
|
15 |
13 |
$274.30 |