| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
4,284 |
3,812 |
$251K |
| D1110 |
Prophylaxis - adult |
3,842 |
3,588 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,550 |
3,298 |
$90K |
| D1120 |
Prophylaxis - child |
1,475 |
1,261 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,091 |
526 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,712 |
1,499 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,185 |
2,926 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,609 |
1,426 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,416 |
1,314 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,520 |
1,373 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
169 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
112 |
$11K |
| D1351 |
Sealant - per tooth |
320 |
77 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
14 |
$3K |
| D2940 |
|
61 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
101 |
77 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
51 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
169 |
93 |
$2K |
| D2140 |
|
30 |
12 |
$2K |
| D7510 |
|
33 |
24 |
$1K |
| X4345 |
|
12 |
12 |
$841.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$762.36 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$394.81 |
| D0602 |
|
27 |
27 |
$0.00 |
| D0603 |
|
1,384 |
1,238 |
$0.00 |
| D0001 |
|
18 |
18 |
$0.00 |