| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,293 |
13,049 |
$253K |
| D1120 |
Prophylaxis - child |
8,128 |
7,998 |
$231K |
| D1110 |
Prophylaxis - adult |
5,303 |
5,188 |
$191K |
| D1206 |
Topical application of fluoride varnish |
10,627 |
10,427 |
$179K |
| D0272 |
Bitewings - two radiographic images |
3,586 |
3,511 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,013 |
1,980 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
331 |
195 |
$21K |
| D0330 |
Panoramic radiographic image |
328 |
321 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
66 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
781 |
767 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
201 |
97 |
$11K |
| D1351 |
Sealant - per tooth |
373 |
108 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
685 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
82 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
85 |
$1K |
| D1354 |
|
121 |
43 |
$997.02 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$464.32 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$329.45 |