| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,276 |
6,247 |
$371K |
| D1120 |
Prophylaxis - child |
8,136 |
8,097 |
$338K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,153 |
8,115 |
$127K |
| D1310 |
|
2,741 |
2,724 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,732 |
793 |
$116K |
| D1351 |
Sealant - per tooth |
3,567 |
940 |
$109K |
| D0274 |
Bitewings - four radiographic images |
3,427 |
3,414 |
$73K |
| D9993 |
|
1,116 |
1,114 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,015 |
6,222 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
971 |
394 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
840 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
667 |
628 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
401 |
399 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,233 |
2,221 |
$26K |
| D0603 |
|
1,588 |
1,579 |
$24K |
| D0350 |
|
1,485 |
678 |
$15K |
| D2140 |
|
124 |
61 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
68 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
55 |
$5K |
| D0601 |
|
308 |
303 |
$5K |
| D0602 |
|
116 |
114 |
$2K |
| D2160 |
|
20 |
14 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D9430 |
|
29 |
28 |
$928.00 |