| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,427 |
9,416 |
$525K |
| D1120 |
Prophylaxis - child |
11,064 |
11,045 |
$435K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,056 |
11,037 |
$142K |
| D1351 |
Sealant - per tooth |
4,412 |
1,141 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,704 |
949 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,305 |
11,220 |
$106K |
| D1310 |
|
2,217 |
2,213 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,039 |
1,900 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,721 |
6,709 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,500 |
3,499 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
863 |
859 |
$53K |
| D9993 |
|
1,026 |
1,026 |
$47K |
| D9430 |
|
671 |
646 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
370 |
235 |
$21K |
| D0603 |
|
1,170 |
1,166 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,105 |
1,070 |
$13K |
| D2140 |
|
206 |
123 |
$11K |
| D0350 |
|
1,272 |
770 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
127 |
126 |
$7K |
| D0602 |
|
235 |
235 |
$4K |
| D0601 |
|
33 |
33 |
$495.00 |