| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,121 |
7,526 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
10,417 |
9,821 |
$164K |
| D1206 |
Topical application of fluoride varnish |
11,185 |
10,460 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,293 |
1,314 |
$99K |
| D1120 |
Prophylaxis - child |
3,996 |
3,838 |
$92K |
| D1351 |
Sealant - per tooth |
4,141 |
719 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,675 |
3,414 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
953 |
904 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,090 |
372 |
$40K |
| D0330 |
Panoramic radiographic image |
994 |
931 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,366 |
1,279 |
$26K |
| D0160 |
|
519 |
487 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,825 |
1,707 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
726 |
692 |
$13K |
| D2140 |
|
355 |
251 |
$11K |
| D0272 |
Bitewings - two radiographic images |
673 |
639 |
$9K |
| D2331 |
|
74 |
51 |
$4K |
| D2160 |
|
35 |
28 |
$2K |
| D9410 |
|
45 |
26 |
$1K |
| D2330 |
|
25 |
12 |
$935.64 |
| D1354 |
|
36 |
12 |
$219.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
14 |
$102.70 |