| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,955 |
3,874 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,058 |
3,956 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,344 |
4,272 |
$84K |
| D1120 |
Prophylaxis - child |
4,055 |
3,969 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,457 |
1,530 |
$70K |
| D9999 |
Unspecified adjunctive procedure, by report |
557 |
544 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,445 |
1,276 |
$62K |
| D9430 |
|
3,171 |
2,988 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
10,248 |
9,206 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,146 |
3,077 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
2,174 |
2,120 |
$42K |
| D0274 |
Bitewings - four radiographic images |
2,359 |
2,333 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,097 |
1,096 |
$18K |
| D1351 |
Sealant - per tooth |
743 |
210 |
$15K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
29 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,518 |
5,758 |
$14K |
| D0272 |
Bitewings - two radiographic images |
2,014 |
1,973 |
$9K |
| D2140 |
|
364 |
243 |
$7K |
| D1999 |
|
480 |
439 |
$2K |
| D7111 |
|
130 |
91 |
$2K |
| D2160 |
|
104 |
72 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
26 |
$2K |
| D9110 |
|
600 |
550 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
163 |
$665.00 |
| D2331 |
|
15 |
12 |
$578.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$185.00 |
| D0602 |
|
86 |
85 |
$6.00 |
| D1330 |
|
5,286 |
5,070 |
$0.00 |
| D9310 |
|
95 |
93 |
$0.00 |
| D1310 |
|
273 |
265 |
$0.00 |
| D1204 |
|
44 |
44 |
$0.00 |
| D0601 |
|
93 |
86 |
$0.00 |
| D9993 |
|
247 |
237 |
$0.00 |
| D1203 |
|
193 |
191 |
$0.00 |