| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,552 |
8,100 |
$333K |
| D8670 |
Periodic orthodontic treatment visit |
3,763 |
3,648 |
$323K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,341 |
1,907 |
$256K |
| D0120 |
Periodic oral evaluation - established patient |
8,915 |
8,409 |
$222K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,771 |
649 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
3,481 |
3,255 |
$178K |
| D1206 |
Topical application of fluoride varnish |
8,496 |
8,059 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
2,000 |
1,906 |
$122K |
| D1120 |
Prophylaxis - child |
1,868 |
1,801 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,475 |
2,326 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,377 |
1,280 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,196 |
2,016 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
959 |
917 |
$23K |
| D2140 |
|
320 |
208 |
$21K |
| D2160 |
|
202 |
145 |
$15K |
| D0272 |
Bitewings - two radiographic images |
419 |
401 |
$12K |
| D0330 |
Panoramic radiographic image |
64 |
61 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$3K |
| D1351 |
Sealant - per tooth |
77 |
12 |
$3K |
| D4910 |
|
52 |
51 |
$2K |
| D4355 |
|
12 |
12 |
$831.24 |
| D9999 |
Unspecified adjunctive procedure, by report |
140 |
132 |
$0.00 |