| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,151 |
3,131 |
$181K |
| D1120 |
Prophylaxis - child |
2,855 |
2,834 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,388 |
1,380 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,814 |
2,800 |
$57K |
| D1206 |
Topical application of fluoride varnish |
4,098 |
4,075 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,206 |
1,199 |
$55K |
| D1110 |
Prophylaxis - adult |
634 |
629 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,442 |
3,930 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
371 |
201 |
$25K |
| D1351 |
Sealant - per tooth |
797 |
221 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
99 |
$15K |
| D0330 |
Panoramic radiographic image |
474 |
473 |
$14K |
| D9430 |
|
449 |
423 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
196 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
69 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
30 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
347 |
334 |
$4K |
| D4910 |
|
48 |
48 |
$4K |
| D0272 |
Bitewings - two radiographic images |
175 |
175 |
$2K |
| D0340 |
|
28 |
28 |
$1K |
| D2140 |
|
21 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$420.00 |