| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,502 |
9,493 |
$507K |
| D1120 |
Prophylaxis - child |
11,105 |
11,073 |
$414K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,699 |
1,968 |
$241K |
| D2160 |
|
2,560 |
1,451 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,500 |
9,931 |
$179K |
| D1310 |
|
2,611 |
2,598 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,821 |
8,791 |
$95K |
| D9993 |
|
1,406 |
1,406 |
$88K |
| D9110 |
|
1,398 |
1,378 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,587 |
3,586 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,497 |
1,444 |
$59K |
| D0272 |
Bitewings - two radiographic images |
5,222 |
5,202 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
852 |
848 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,183 |
2,166 |
$44K |
| D0603 |
|
2,171 |
2,164 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
542 |
309 |
$30K |
| D1351 |
Sealant - per tooth |
1,150 |
450 |
$28K |
| D2161 |
|
291 |
232 |
$24K |
| D9430 |
|
730 |
722 |
$23K |
| D2140 |
|
401 |
222 |
$21K |
| D0350 |
|
1,990 |
733 |
$20K |
| D0330 |
Panoramic radiographic image |
649 |
649 |
$19K |
| D1354 |
|
1,398 |
285 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
220 |
219 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
182 |
182 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
318 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
18 |
$2K |
| D0601 |
|
26 |
26 |
$390.00 |
| D0270 |
|
72 |
71 |
$350.00 |