| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,752 |
10,574 |
$639K |
| D0120 |
Periodic oral evaluation - established patient |
12,920 |
12,873 |
$487K |
| D0274 |
Bitewings - four radiographic images |
9,806 |
9,761 |
$432K |
| D1206 |
Topical application of fluoride varnish |
13,052 |
13,009 |
$386K |
| D1120 |
Prophylaxis - child |
7,258 |
7,249 |
$300K |
| D0330 |
Panoramic radiographic image |
3,391 |
3,381 |
$290K |
| D0140 |
Limited oral evaluation - problem focused |
3,376 |
3,290 |
$144K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,487 |
1,114 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,743 |
2,733 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,318 |
1,055 |
$106K |
| D1351 |
Sealant - per tooth |
1,803 |
546 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
546 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
267 |
$43K |
| D2140 |
|
482 |
359 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,045 |
2,005 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,179 |
986 |
$24K |
| D2331 |
|
111 |
79 |
$13K |
| D2160 |
|
115 |
97 |
$13K |
| D0272 |
Bitewings - two radiographic images |
301 |
300 |
$11K |
| D1330 |
|
201 |
201 |
$8K |
| D2330 |
|
49 |
37 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
38 |
$3K |
| D9920 |
|
14 |
12 |
$1K |