| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,968 |
5,845 |
$407K |
| D1120 |
Prophylaxis - child |
4,312 |
4,208 |
$80K |
| D1110 |
Prophylaxis - adult |
2,020 |
1,972 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
6,216 |
6,049 |
$44K |
| D1206 |
Topical application of fluoride varnish |
4,731 |
4,612 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,649 |
2,591 |
$39K |
| D0272 |
Bitewings - two radiographic images |
3,184 |
3,109 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,982 |
5,827 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
189 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
369 |
204 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
127 |
$13K |
| D0330 |
Panoramic radiographic image |
518 |
503 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
67 |
$7K |
| D1351 |
Sealant - per tooth |
153 |
45 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
76 |
$2K |
| D2140 |
|
38 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$15.56 |