| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,955 |
6,640 |
$326K |
| D0120 |
Periodic oral evaluation - established patient |
7,044 |
6,724 |
$154K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,660 |
1,100 |
$112K |
| D0272 |
Bitewings - two radiographic images |
4,286 |
4,064 |
$96K |
| D2160 |
|
1,184 |
732 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,881 |
1,665 |
$89K |
| D2332 |
|
490 |
263 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,117 |
2,004 |
$36K |
| D0330 |
Panoramic radiographic image |
788 |
728 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,151 |
1,044 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
914 |
$29K |
| D1120 |
Prophylaxis - child |
968 |
929 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
851 |
776 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
288 |
81 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
102 |
$14K |
| D1206 |
Topical application of fluoride varnish |
596 |
576 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
721 |
591 |
$7K |
| D1351 |
Sealant - per tooth |
417 |
68 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
257 |
239 |
$3K |
| D1320 |
|
25 |
25 |
$256.00 |
| D9920 |
|
21 |
18 |
$0.00 |