| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,017 |
2,958 |
$400K |
| D0140 |
Limited oral evaluation - problem focused |
1,747 |
1,654 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
6,203 |
5,743 |
$122K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,133 |
626 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
241 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,424 |
4,058 |
$35K |
| D0274 |
Bitewings - four radiographic images |
3,800 |
3,720 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
51 |
25 |
$29K |
| D0330 |
Panoramic radiographic image |
130 |
130 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
155 |
$21K |
| D2140 |
|
459 |
290 |
$19K |
| D1110 |
Prophylaxis - adult |
1,124 |
1,091 |
$17K |
| D1351 |
Sealant - per tooth |
677 |
131 |
$15K |
| D1206 |
Topical application of fluoride varnish |
2,118 |
2,087 |
$10K |
| D1120 |
Prophylaxis - child |
1,867 |
1,836 |
$10K |
| D2160 |
|
130 |
88 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
58 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
39 |
$4K |
| D2950 |
|
38 |
25 |
$4K |
| D2331 |
|
69 |
42 |
$3K |
| D0470 |
|
40 |
31 |
$2K |
| D9248 |
|
12 |
12 |
$2K |
| D0603 |
|
438 |
428 |
$0.00 |
| D9211 |
|
524 |
307 |
$0.00 |
| D7111 |
|
25 |
12 |
$0.00 |
| D0350 |
|
16 |
12 |
$0.00 |