| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,047 |
3,890 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,247 |
5,030 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,233 |
919 |
$71K |
| D1110 |
Prophylaxis - adult |
1,518 |
1,479 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,451 |
2,296 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,767 |
2,670 |
$46K |
| D4341 |
|
267 |
176 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,548 |
1,495 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,842 |
4,611 |
$28K |
| D1206 |
Topical application of fluoride varnish |
769 |
768 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,664 |
3,374 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,266 |
1,196 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
305 |
251 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
244 |
222 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
578 |
569 |
$12K |
| D1351 |
Sealant - per tooth |
185 |
109 |
$11K |
| D9110 |
|
177 |
173 |
$10K |
| D5110 |
|
25 |
25 |
$9K |
| D0272 |
Bitewings - two radiographic images |
746 |
700 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
96 |
$6K |
| D2140 |
|
146 |
120 |
$6K |
| D5120 |
|
12 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
90 |
$4K |
| D2331 |
|
14 |
12 |
$934.20 |
| D0270 |
|
139 |
134 |
$752.20 |
| D1999 |
|
767 |
619 |
$0.00 |