| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,644 |
3,477 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
5,057 |
4,799 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,710 |
2,583 |
$70K |
| D1110 |
Prophylaxis - adult |
1,511 |
1,441 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
766 |
543 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,923 |
2,786 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,400 |
5,130 |
$32K |
| D1351 |
Sealant - per tooth |
403 |
182 |
$28K |
| D0330 |
Panoramic radiographic image |
1,141 |
1,081 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,159 |
1,117 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,350 |
1,272 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,721 |
4,450 |
$19K |
| D4341 |
|
93 |
58 |
$16K |
| D0272 |
Bitewings - two radiographic images |
552 |
523 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
62 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
27 |
$2K |
| D9110 |
|
24 |
24 |
$1K |
| D0190 |
|
118 |
108 |
$0.00 |
| D1999 |
|
131 |
129 |
$0.00 |