| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,411 |
20,679 |
$565K |
| D1120 |
Prophylaxis - child |
12,867 |
11,152 |
$416K |
| D1110 |
Prophylaxis - adult |
8,902 |
8,147 |
$392K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,617 |
18,252 |
$361K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,620 |
792 |
$348K |
| D0272 |
Bitewings - two radiographic images |
11,649 |
10,419 |
$230K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,109 |
5,217 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
1,475 |
1,361 |
$108K |
| D2140 |
|
928 |
589 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,717 |
2,510 |
$43K |
| D9248 |
|
433 |
377 |
$40K |
| D0603 |
|
7,997 |
7,234 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
479 |
302 |
$27K |
| D0602 |
|
4,561 |
4,220 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
160 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,307 |
1,112 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
507 |
465 |
$15K |
| D0330 |
Panoramic radiographic image |
711 |
701 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
51 |
$7K |
| D0601 |
|
1,370 |
1,228 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
28 |
$3K |