| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,453 |
3,438 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,041 |
5,315 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,792 |
1,791 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,642 |
1,052 |
$108K |
| D1120 |
Prophylaxis - child |
2,769 |
2,763 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,030 |
680 |
$81K |
| D1110 |
Prophylaxis - adult |
889 |
887 |
$75K |
| D1351 |
Sealant - per tooth |
3,065 |
697 |
$72K |
| D0272 |
Bitewings - two radiographic images |
5,216 |
5,201 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
386 |
283 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,866 |
3,860 |
$43K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
69 |
56 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
434 |
270 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
363 |
226 |
$20K |
| D2160 |
|
149 |
101 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
132 |
$11K |
| D0350 |
|
1,319 |
741 |
$10K |
| D7230 |
|
45 |
41 |
$9K |
| D2952 |
|
24 |
24 |
$2K |
| D2140 |
|
46 |
29 |
$2K |
| D3221 |
|
15 |
14 |
$945.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$560.00 |
| D9430 |
|
12 |
12 |
$384.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$270.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
55 |
$90.00 |