| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,025 |
5,991 |
$313K |
| D0330 |
Panoramic radiographic image |
3,362 |
3,330 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,854 |
1,572 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
6,132 |
6,113 |
$200K |
| D0274 |
Bitewings - four radiographic images |
3,943 |
3,917 |
$138K |
| D1120 |
Prophylaxis - child |
3,412 |
3,409 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,274 |
3,244 |
$117K |
| D2140 |
|
1,716 |
1,020 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,197 |
2,164 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,924 |
2,904 |
$71K |
| D2160 |
|
708 |
437 |
$68K |
| D0272 |
Bitewings - two radiographic images |
1,624 |
1,622 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
426 |
275 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,677 |
2,472 |
$38K |
| D2950 |
|
96 |
64 |
$19K |
| D2710 |
|
27 |
12 |
$11K |
| D1330 |
|
437 |
412 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
522 |
366 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
52 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
56 |
$5K |
| D1351 |
Sealant - per tooth |
205 |
47 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
29 |
$3K |
| D7230 |
|
17 |
12 |
$2K |
| D9985 |
|
82 |
79 |
$0.00 |