| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,442 |
3,426 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
4,074 |
4,053 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,130 |
2,123 |
$136K |
| D1120 |
Prophylaxis - child |
2,442 |
2,432 |
$97K |
| D1206 |
Topical application of fluoride varnish |
5,911 |
5,885 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,543 |
708 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,296 |
4,597 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
962 |
596 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
444 |
268 |
$53K |
| D9430 |
|
1,523 |
1,471 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,165 |
2,153 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,435 |
3,313 |
$41K |
| D9110 |
|
639 |
631 |
$40K |
| D0330 |
Panoramic radiographic image |
622 |
616 |
$19K |
| D0240 |
|
1,584 |
803 |
$16K |
| D2330 |
|
182 |
96 |
$14K |
| D2140 |
|
181 |
112 |
$10K |
| D1351 |
Sealant - per tooth |
391 |
84 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
14 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
125 |
$6K |
| D1999 |
|
863 |
816 |
$76.00 |
| D0190 |
|
746 |
707 |
$0.00 |