| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,533 |
14,137 |
$757K |
| D0120 |
Periodic oral evaluation - established patient |
16,336 |
15,930 |
$522K |
| D1206 |
Topical application of fluoride varnish |
17,273 |
16,868 |
$474K |
| D0330 |
Panoramic radiographic image |
6,104 |
5,938 |
$438K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,973 |
2,068 |
$421K |
| D0274 |
Bitewings - four radiographic images |
11,384 |
11,014 |
$414K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,841 |
1,987 |
$400K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,139 |
3,076 |
$368K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,411 |
2,246 |
$353K |
| D1120 |
Prophylaxis - child |
7,541 |
7,377 |
$275K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,779 |
6,609 |
$258K |
| D1351 |
Sealant - per tooth |
10,897 |
1,801 |
$245K |
| D2140 |
|
4,866 |
2,558 |
$223K |
| D2331 |
|
2,282 |
1,330 |
$217K |
| D2160 |
|
2,291 |
1,609 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
4,527 |
4,282 |
$167K |
| D0272 |
Bitewings - two radiographic images |
3,823 |
3,742 |
$127K |
| D2330 |
|
1,394 |
861 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
705 |
468 |
$93K |
| D1330 |
|
2,610 |
2,549 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
4,716 |
4,480 |
$67K |
| D0240 |
|
2,100 |
1,032 |
$61K |
| D2332 |
|
251 |
170 |
$23K |
| D2335 |
|
171 |
118 |
$21K |
| D2721 |
|
21 |
13 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
738 |
660 |
$7K |
| D4341 |
|
26 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
380 |
$4K |
| D2161 |
|
26 |
25 |
$4K |
| D2950 |
|
18 |
13 |
$3K |
| D4910 |
|
13 |
13 |
$1K |
| D4355 |
|
111 |
86 |
$281.22 |
| D0191 |
|
27 |
14 |
$0.00 |