| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,640 |
3,639 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,413 |
1,312 |
$161K |
| D1120 |
Prophylaxis - child |
3,986 |
3,980 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,289 |
1,168 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,212 |
2,211 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,594 |
3,813 |
$41K |
| D1206 |
Topical application of fluoride varnish |
3,961 |
3,953 |
$39K |
| D2160 |
|
218 |
172 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,277 |
1,273 |
$15K |
| D2140 |
|
219 |
153 |
$12K |
| D0350 |
|
804 |
537 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
117 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
106 |
$5K |
| D1351 |
Sealant - per tooth |
115 |
31 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$492.00 |