| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
6,603 |
6,508 |
$382K |
| D1120 |
Prophylaxis - child |
6,199 |
6,125 |
$223K |
| D1110 |
Prophylaxis - adult |
4,179 |
4,139 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
6,642 |
6,588 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,592 |
5,543 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,159 |
635 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,039 |
1,919 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,160 |
634 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,087 |
3,045 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,535 |
2,495 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,173 |
1,106 |
$45K |
| D2140 |
|
585 |
308 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,179 |
2,055 |
$32K |
| D7111 |
|
301 |
178 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
284 |
283 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
621 |
$11K |
| D1351 |
Sealant - per tooth |
193 |
47 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
338 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$2K |