| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,373 |
3,356 |
$261K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,372 |
3,354 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
3,890 |
3,865 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
853 |
621 |
$99K |
| D1120 |
Prophylaxis - child |
2,897 |
2,887 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,659 |
4,950 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,952 |
1,942 |
$88K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
873 |
601 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,358 |
2,353 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
703 |
337 |
$39K |
| D0272 |
Bitewings - two radiographic images |
3,823 |
3,809 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,856 |
2,846 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,286 |
2,256 |
$17K |
| D1320 |
|
908 |
908 |
$15K |
| D9430 |
|
397 |
396 |
$13K |
| D1351 |
Sealant - per tooth |
300 |
88 |
$6K |
| D2140 |
|
102 |
67 |
$5K |
| D1310 |
|
311 |
310 |
$2K |
| D0350 |
|
230 |
155 |
$2K |
| D4341 |
|
74 |
14 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$1K |
| D0601 |
|
230 |
229 |
$592.00 |
| D0602 |
|
13 |
13 |
$30.00 |
| D9993 |
|
18 |
18 |
$0.00 |
| D1330 |
|
943 |
921 |
$0.00 |