| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,715 |
3,649 |
$135K |
| D1120 |
Prophylaxis - child |
2,820 |
2,778 |
$127K |
| D1206 |
Topical application of fluoride varnish |
4,288 |
4,206 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
782 |
359 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,692 |
2,653 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
647 |
371 |
$84K |
| D1351 |
Sealant - per tooth |
1,873 |
567 |
$69K |
| D2140 |
|
728 |
459 |
$65K |
| D1110 |
Prophylaxis - adult |
488 |
478 |
$31K |
| D0330 |
Panoramic radiographic image |
333 |
331 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
698 |
572 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
479 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
621 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
215 |
192 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
226 |
220 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
43 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
102 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
177 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
40 |
$4K |
| D0274 |
Bitewings - four radiographic images |
75 |
74 |
$3K |