| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,203 |
3,119 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
4,129 |
4,095 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,368 |
2,313 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,711 |
6,401 |
$125K |
| D1120 |
Prophylaxis - child |
3,047 |
3,030 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,201 |
836 |
$74K |
| D9430 |
|
2,178 |
1,970 |
$63K |
| D0272 |
Bitewings - two radiographic images |
5,280 |
5,207 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,232 |
3,147 |
$40K |
| D1206 |
Topical application of fluoride varnish |
3,006 |
2,994 |
$36K |
| D1351 |
Sealant - per tooth |
1,350 |
304 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
106 |
$15K |
| D2330 |
|
127 |
89 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
104 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
181 |
$7K |
| D2140 |
|
93 |
70 |
$5K |
| D9993 |
|
12 |
12 |
$720.00 |
| D1310 |
|
12 |
12 |
$552.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$97.00 |
| D1999 |
|
295 |
225 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
100 |
95 |
$0.00 |