| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,947 |
2,924 |
$162K |
| D1120 |
Prophylaxis - child |
3,226 |
3,200 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,305 |
1,295 |
$80K |
| D1110 |
Prophylaxis - adult |
922 |
914 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,671 |
4,122 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,507 |
3,464 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,304 |
1,294 |
$27K |
| D1310 |
|
556 |
554 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,788 |
1,784 |
$21K |
| D9993 |
|
556 |
554 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,650 |
1,583 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
175 |
84 |
$12K |
| D1206 |
Topical application of fluoride varnish |
695 |
695 |
$10K |
| D9430 |
|
273 |
269 |
$9K |
| D0603 |
|
553 |
550 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
63 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
61 |
12 |
$2K |
| D0350 |
|
80 |
49 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |