| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,889 |
3,736 |
$96K |
| D1120 |
Prophylaxis - child |
2,678 |
2,573 |
$79K |
| D1110 |
Prophylaxis - adult |
2,246 |
2,144 |
$60K |
| D0330 |
Panoramic radiographic image |
605 |
574 |
$42K |
| D1351 |
Sealant - per tooth |
2,607 |
698 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
435 |
205 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
361 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
201 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,424 |
1,369 |
$4K |
| D2160 |
|
21 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
103 |
$1K |
| D0272 |
Bitewings - two radiographic images |
1,129 |
1,089 |
$1K |
| D1330 |
|
5,039 |
4,833 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,531 |
3,390 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
704 |
648 |
$880.76 |
| D1999 |
|
12 |
12 |
$480.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| D0601 |
|
43 |
42 |
$34.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
67 |
$31.80 |