| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,400 |
4,234 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
5,953 |
5,704 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,242 |
963 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,518 |
3,397 |
$91K |
| D1110 |
Prophylaxis - adult |
1,770 |
1,705 |
$74K |
| D4341 |
|
481 |
254 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,642 |
3,507 |
$61K |
| D1351 |
Sealant - per tooth |
824 |
322 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,666 |
6,383 |
$40K |
| D0330 |
Panoramic radiographic image |
1,615 |
1,565 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,593 |
1,546 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,702 |
5,443 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,096 |
1,060 |
$18K |
| D9110 |
|
315 |
303 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,075 |
1,023 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
68 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
89 |
$6K |
| D2160 |
|
55 |
39 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
76 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
28 |
$2K |
| D2332 |
|
14 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$866.70 |
| D1999 |
|
121 |
110 |
$0.00 |
| D0190 |
|
102 |
94 |
$0.00 |