| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,505 |
13,466 |
$781K |
| D1120 |
Prophylaxis - child |
16,343 |
16,293 |
$645K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91,222 |
17,112 |
$365K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,134 |
3,279 |
$335K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,574 |
3,562 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,065 |
16,020 |
$211K |
| D1351 |
Sealant - per tooth |
7,010 |
2,663 |
$208K |
| D0272 |
Bitewings - two radiographic images |
14,631 |
14,591 |
$171K |
| D2140 |
|
2,592 |
1,755 |
$137K |
| D9430 |
|
3,260 |
3,067 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,562 |
1,203 |
$88K |
| D0350 |
|
6,079 |
3,921 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
662 |
660 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,109 |
3,054 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
374 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
158 |
89 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
223 |
205 |
$9K |
| D2160 |
|
102 |
88 |
$8K |
| D3240 |
|
72 |
48 |
$7K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$300.00 |