| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,874 |
7,667 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
9,710 |
9,431 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,679 |
10,378 |
$217K |
| D1110 |
Prophylaxis - adult |
4,620 |
4,453 |
$195K |
| D0274 |
Bitewings - four radiographic images |
5,070 |
4,903 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,831 |
2,728 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,366 |
1,293 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
566 |
324 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
553 |
278 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,901 |
1,848 |
$24K |
| D2140 |
|
413 |
248 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,070 |
1,020 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
732 |
592 |
$20K |
| D1351 |
Sealant - per tooth |
567 |
149 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,396 |
$17K |
| D1206 |
Topical application of fluoride varnish |
594 |
583 |
$12K |
| D2160 |
|
161 |
87 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
548 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
68 |
$6K |
| D0330 |
Panoramic radiographic image |
79 |
77 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
24 |
$2K |
| D1999 |
|
22 |
21 |
$0.00 |