| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,099 |
4,766 |
$216K |
| D0120 |
Periodic oral evaluation - established patient |
7,584 |
7,087 |
$151K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,843 |
1,114 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,498 |
791 |
$102K |
| D0330 |
Panoramic radiographic image |
1,637 |
1,522 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,818 |
2,629 |
$85K |
| D1120 |
Prophylaxis - child |
2,733 |
2,571 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,019 |
1,842 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,941 |
2,731 |
$57K |
| D2140 |
|
1,013 |
666 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,965 |
1,842 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
979 |
897 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,452 |
1,375 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
918 |
753 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
475 |
$12K |
| D2160 |
|
140 |
103 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
856 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
43 |
$5K |
| D1351 |
Sealant - per tooth |
223 |
42 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$161.00 |