| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
6,245 |
5,533 |
$374K |
| D1110 |
Prophylaxis - adult |
4,569 |
4,263 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,310 |
4,006 |
$110K |
| D1120 |
Prophylaxis - child |
2,027 |
1,987 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
4,387 |
4,146 |
$92K |
| D1206 |
Topical application of fluoride varnish |
2,157 |
2,097 |
$83K |
| D0274 |
Bitewings - four radiographic images |
1,933 |
1,824 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,514 |
1,392 |
$19K |
| D1351 |
Sealant - per tooth |
390 |
115 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
105 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
104 |
$8K |
| X4345 |
|
111 |
105 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
248 |
$7K |
| D0272 |
Bitewings - two radiographic images |
263 |
257 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
143 |
$5K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
38 |
$3K |
| D2140 |
|
51 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
215 |
124 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
24 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$364.44 |
| D0603 |
|
1,477 |
1,333 |
$0.00 |
| D0001 |
|
20 |
20 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |