| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,797 |
4,796 |
$277K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,236 |
1,433 |
$210K |
| D1120 |
Prophylaxis - child |
5,168 |
5,159 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,053 |
5,879 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,036 |
2,028 |
$123K |
| D1206 |
Topical application of fluoride varnish |
6,728 |
6,716 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,441 |
3,437 |
$72K |
| D1110 |
Prophylaxis - adult |
781 |
779 |
$66K |
| D2140 |
|
1,188 |
609 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,023 |
1,019 |
$47K |
| D1351 |
Sealant - per tooth |
1,872 |
538 |
$45K |
| D9430 |
|
1,168 |
1,095 |
$36K |
| D1310 |
|
549 |
547 |
$24K |
| D0350 |
|
2,104 |
1,118 |
$21K |
| D9993 |
|
319 |
318 |
$20K |
| D2160 |
|
213 |
121 |
$16K |
| D4341 |
|
221 |
58 |
$14K |
| D2330 |
|
177 |
85 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
323 |
308 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,035 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
790 |
778 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
96 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
52 |
$6K |
| D4910 |
|
38 |
38 |
$3K |
| D0602 |
|
26 |
26 |
$345.00 |
| D0270 |
|
30 |
29 |
$150.00 |