| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,070 |
6,012 |
$296K |
| D0120 |
Periodic oral evaluation - established patient |
7,380 |
7,316 |
$237K |
| D1206 |
Topical application of fluoride varnish |
8,096 |
8,002 |
$217K |
| D0274 |
Bitewings - four radiographic images |
5,301 |
5,258 |
$185K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,429 |
1,724 |
$181K |
| D0330 |
Panoramic radiographic image |
2,324 |
2,294 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
3,760 |
3,619 |
$129K |
| D1120 |
Prophylaxis - child |
3,293 |
3,277 |
$118K |
| D2140 |
|
1,871 |
1,315 |
$118K |
| D1351 |
Sealant - per tooth |
2,676 |
697 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,120 |
2,113 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,178 |
2,166 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
356 |
$47K |
| D2331 |
|
485 |
357 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,193 |
3,120 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
612 |
342 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,169 |
1,059 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
180 |
$16K |
| D2160 |
|
171 |
151 |
$16K |
| D2330 |
|
117 |
87 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
502 |
355 |
$5K |
| D2332 |
|
16 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D9110 |
|
12 |
12 |
$590.88 |
| D1999 |
|
1,022 |
927 |
$34.18 |
| D9995 |
|
27 |
27 |
$0.00 |