| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
3,631 |
3,195 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
1,436 |
1,383 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
720 |
666 |
$64K |
| D1110 |
Prophylaxis - adult |
1,262 |
1,222 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
313 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,603 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
95 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,881 |
2,195 |
$14K |
| D1206 |
Topical application of fluoride varnish |
772 |
750 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
49 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
53 |
$7K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$910.92 |
| D1120 |
Prophylaxis - child |
175 |
166 |
$673.60 |
| D0272 |
Bitewings - two radiographic images |
44 |
39 |
$2.96 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D1330 |
|
409 |
380 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
101 |
$0.00 |