| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,219 |
3,209 |
$96K |
| D1110 |
Prophylaxis - adult |
2,463 |
2,447 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,765 |
2,755 |
$77K |
| D1206 |
Topical application of fluoride varnish |
4,730 |
4,714 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,033 |
3,020 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,698 |
2,684 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
614 |
313 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,370 |
1,311 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,915 |
2,411 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
108 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,153 |
1,030 |
$18K |
| D2140 |
|
297 |
161 |
$15K |
| D1351 |
Sealant - per tooth |
219 |
53 |
$7K |
| D1999 |
|
337 |
311 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
54 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
80 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$1K |
| D9920 |
|
15 |
14 |
$825.00 |
| D4910 |
|
68 |
67 |
$560.00 |
| D1330 |
|
373 |
371 |
$0.00 |