| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,691 |
3,400 |
$100K |
| D9110 |
|
2,110 |
1,939 |
$98K |
| D1120 |
Prophylaxis - child |
1,960 |
1,820 |
$77K |
| D4341 |
|
441 |
158 |
$74K |
| D1110 |
Prophylaxis - adult |
1,264 |
1,176 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,846 |
1,713 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,480 |
2,299 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,691 |
4,439 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,249 |
4,455 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,814 |
1,637 |
$17K |
| D1351 |
Sealant - per tooth |
79 |
27 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
57 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
137 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
29 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$2K |
| D2330 |
|
21 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$1K |
| D2140 |
|
28 |
14 |
$832.95 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
14 |
$3.80 |
| D1999 |
|
87 |
71 |
$0.00 |