| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,515 |
1,385 |
$402.89 |
| D0120 |
Periodic oral evaluation - established patient |
2,219 |
2,046 |
$392.00 |
| D1110 |
Prophylaxis - adult |
1,319 |
1,205 |
$269.48 |
| D0140 |
Limited oral evaluation - problem focused |
1,038 |
944 |
$264.13 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,570 |
1,456 |
$171.46 |
| D0220 |
Intraoral - periapical first radiographic image |
2,772 |
2,488 |
$168.32 |
| D0274 |
Bitewings - four radiographic images |
1,720 |
1,595 |
$145.00 |
| D0272 |
Bitewings - two radiographic images |
969 |
879 |
$129.74 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
984 |
872 |
$93.22 |
| D7140 |
Extraction, erupted tooth or exposed root |
872 |
307 |
$80.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
183 |
109 |
$66.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,133 |
1,681 |
$56.14 |
| D1354 |
|
116 |
63 |
$42.00 |
| D0601 |
|
1,030 |
981 |
$11.00 |
| D2140 |
|
151 |
80 |
$0.00 |
| D0330 |
Panoramic radiographic image |
273 |
235 |
$0.00 |
| D1999 |
|
75 |
66 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D4910 |
|
14 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
83 |
82 |
$0.00 |
| D0603 |
|
174 |
162 |
$0.00 |
| D1351 |
Sealant - per tooth |
32 |
12 |
$0.00 |
| D0602 |
|
26 |
26 |
$0.00 |
| D1330 |
|
17 |
16 |
$0.00 |