| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,707 |
4,592 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
8,231 |
8,035 |
$141K |
| D1120 |
Prophylaxis - child |
4,565 |
4,450 |
$119K |
| D1206 |
Topical application of fluoride varnish |
6,752 |
6,572 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,011 |
1,946 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
650 |
452 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,165 |
1,143 |
$28K |
| D0330 |
Panoramic radiographic image |
1,203 |
1,178 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
627 |
603 |
$27K |
| D2140 |
|
602 |
419 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,117 |
1,091 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
376 |
247 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,231 |
1,195 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,346 |
1,303 |
$12K |
| D0603 |
|
1,052 |
1,026 |
$5K |
| D1351 |
Sealant - per tooth |
187 |
31 |
$5K |
| D0601 |
|
771 |
759 |
$3K |
| D0602 |
|
633 |
622 |
$3K |
| D2331 |
|
44 |
27 |
$3K |
| D2330 |
|
42 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$106.34 |
| D1999 |
|
58 |
57 |
$0.00 |