| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,973 |
8,965 |
$482K |
| D1120 |
Prophylaxis - child |
10,892 |
10,874 |
$402K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,279 |
3,010 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,797 |
10,777 |
$116K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,785 |
1,098 |
$115K |
| D1351 |
Sealant - per tooth |
3,963 |
1,494 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,361 |
4,354 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,634 |
11,156 |
$90K |
| D1310 |
|
1,980 |
1,978 |
$88K |
| D9993 |
|
1,220 |
1,219 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
970 |
627 |
$61K |
| D0272 |
Bitewings - two radiographic images |
4,571 |
4,563 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
590 |
$35K |
| D2140 |
|
509 |
342 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
457 |
245 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
378 |
260 |
$20K |
| D0603 |
|
958 |
958 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
964 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
142 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
114 |
$5K |
| D0601 |
|
271 |
271 |
$4K |
| D2330 |
|
30 |
16 |
$2K |
| D2160 |
|
19 |
16 |
$2K |
| D0602 |
|
17 |
17 |
$255.00 |
| D1999 |
|
213 |
197 |
$45.00 |