| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,809 |
3,793 |
$318K |
| D0120 |
Periodic oral evaluation - established patient |
5,534 |
5,516 |
$307K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,292 |
3,286 |
$203K |
| D1120 |
Prophylaxis - child |
5,145 |
5,121 |
$189K |
| D1351 |
Sealant - per tooth |
6,663 |
1,461 |
$171K |
| D0210 |
Intraoral - complete series of radiographic images |
2,743 |
2,728 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,928 |
8,863 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,822 |
5,542 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,828 |
3,813 |
$81K |
| D9430 |
|
1,566 |
1,514 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,056 |
2,904 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
289 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
185 |
114 |
$22K |
| D9993 |
|
352 |
352 |
$20K |
| D4341 |
|
271 |
78 |
$19K |
| D1310 |
|
352 |
352 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
112 |
$13K |
| D0272 |
Bitewings - two radiographic images |
992 |
991 |
$12K |
| D4910 |
|
128 |
128 |
$10K |
| D2160 |
|
60 |
31 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
38 |
$4K |
| D0601 |
|
235 |
235 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
55 |
$2K |