| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,977 |
11,680 |
$377K |
| D9920 |
|
16,270 |
11,475 |
$363K |
| D1206 |
Topical application of fluoride varnish |
10,346 |
10,115 |
$219K |
| D1110 |
Prophylaxis - adult |
6,989 |
6,767 |
$218K |
| D1120 |
Prophylaxis - child |
3,480 |
3,445 |
$74K |
| D4210 |
|
990 |
271 |
$72K |
| D4341 |
|
1,730 |
459 |
$71K |
| D9999 |
Unspecified adjunctive procedure, by report |
584 |
576 |
$66K |
| D9420 |
|
201 |
199 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,311 |
1,259 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,900 |
1,813 |
$30K |
| D0603 |
|
5,024 |
4,572 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,658 |
1,628 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
490 |
468 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,324 |
2,279 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
222 |
165 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,990 |
1,679 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
49 |
$5K |
| D0272 |
Bitewings - two radiographic images |
419 |
414 |
$2K |
| D2140 |
|
37 |
26 |
$1K |
| D9910 |
|
201 |
199 |
$995.00 |
| D1351 |
Sealant - per tooth |
89 |
25 |
$943.40 |
| D0330 |
Panoramic radiographic image |
68 |
67 |
$918.50 |
| D0470 |
|
184 |
46 |
$160.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$59.36 |
| D0999 |
Unspecified diagnostic procedure, by report |
43 |
41 |
$0.00 |
| D1999 |
|
55 |
55 |
$0.00 |