| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,773 |
1,041 |
$191K |
| D1110 |
Prophylaxis - adult |
2,866 |
2,724 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,200 |
3,960 |
$108K |
| D8670 |
Periodic orthodontic treatment visit |
819 |
594 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,947 |
2,816 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
861 |
571 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,207 |
1,789 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,400 |
2,239 |
$46K |
| D2140 |
|
416 |
286 |
$26K |
| D1120 |
Prophylaxis - child |
717 |
676 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,352 |
1,242 |
$23K |
| D2160 |
|
221 |
149 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,041 |
1,032 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
96 |
$8K |
| D0601 |
|
1,496 |
1,436 |
$7K |
| D0330 |
Panoramic radiographic image |
136 |
120 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
148 |
$5K |
| D1351 |
Sealant - per tooth |
34 |
12 |
$796.50 |
| D9920 |
|
29 |
29 |
$580.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
12 |
$376.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$200.52 |
| D0602 |
|
12 |
12 |
$55.00 |