| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,228 |
8,045 |
$301K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,715 |
11,641 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
11,664 |
11,499 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,974 |
7,108 |
$183K |
| D1120 |
Prophylaxis - child |
6,379 |
6,334 |
$177K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,667 |
1,988 |
$164K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,977 |
1,066 |
$136K |
| D0274 |
Bitewings - four radiographic images |
6,326 |
6,186 |
$130K |
| D9630 |
|
7,555 |
7,479 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,274 |
4,128 |
$119K |
| D0330 |
Panoramic radiographic image |
2,687 |
1,933 |
$99K |
| D1351 |
Sealant - per tooth |
2,702 |
792 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
8,750 |
3,905 |
$69K |
| D2140 |
|
1,163 |
859 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
7,315 |
5,898 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,912 |
2,899 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,741 |
2,062 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
944 |
898 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
46 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
86 |
$7K |
| D2331 |
|
141 |
92 |
$6K |
| D2160 |
|
80 |
75 |
$4K |
| D2332 |
|
32 |
25 |
$2K |
| D3120 |
|
157 |
121 |
$2K |
| D2330 |
|
24 |
12 |
$1K |
| D4346 |
|
12 |
12 |
$0.00 |