| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,819 |
7,814 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
8,928 |
8,921 |
$193K |
| D0220 |
Intraoral - periapical first radiographic image |
12,786 |
12,563 |
$130K |
| D0272 |
Bitewings - two radiographic images |
9,610 |
9,608 |
$120K |
| D1120 |
Prophylaxis - child |
3,152 |
3,149 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,288 |
11,212 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,569 |
5,565 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,054 |
785 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,438 |
1,027 |
$53K |
| D1351 |
Sealant - per tooth |
831 |
392 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,320 |
859 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,295 |
2,295 |
$51K |
| D9990 |
|
1,550 |
1,411 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
384 |
327 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,596 |
2,533 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
67 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
127 |
124 |
$2K |
| D2140 |
|
34 |
27 |
$1K |
| D1999 |
|
128 |
108 |
$0.00 |