| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,536 |
15,501 |
$404K |
| D1120 |
Prophylaxis - child |
11,091 |
10,357 |
$358K |
| D1206 |
Topical application of fluoride varnish |
16,162 |
15,142 |
$287K |
| D0272 |
Bitewings - two radiographic images |
11,149 |
10,434 |
$249K |
| D0240 |
|
10,725 |
5,036 |
$245K |
| D1110 |
Prophylaxis - adult |
5,191 |
4,914 |
$230K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,174 |
298 |
$160K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,477 |
707 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,811 |
3,346 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,036 |
548 |
$71K |
| D9248 |
|
759 |
698 |
$65K |
| D0603 |
|
15,485 |
14,633 |
$59K |
| D0330 |
Panoramic radiographic image |
892 |
877 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,054 |
1,981 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
727 |
694 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,504 |
1,433 |
$19K |
| D1351 |
Sealant - per tooth |
352 |
123 |
$9K |
| D2160 |
|
88 |
42 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
42 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
61 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
14 |
$2K |
| D0602 |
|
303 |
209 |
$1K |
| D9215 |
|
662 |
539 |
$0.00 |