| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
23,214 |
3,217 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
1,773 |
1,771 |
$102K |
| D1110 |
Prophylaxis - adult |
902 |
899 |
$78K |
| D2140 |
|
1,366 |
513 |
$74K |
| D1120 |
Prophylaxis - child |
1,712 |
1,710 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
911 |
910 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,163 |
3,079 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,884 |
2,877 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
698 |
593 |
$27K |
| D9430 |
|
714 |
675 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
242 |
132 |
$16K |
| D4910 |
|
86 |
86 |
$7K |
| D7111 |
|
93 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
321 |
319 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$540.00 |
| D0350 |
|
24 |
13 |
$230.40 |