| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,705 |
4,482 |
$127K |
| D1110 |
Prophylaxis - adult |
2,676 |
2,475 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,180 |
626 |
$102K |
| D1120 |
Prophylaxis - child |
2,568 |
2,530 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,626 |
2,215 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,237 |
3,188 |
$67K |
| D2140 |
|
959 |
537 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,493 |
3,354 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
917 |
434 |
$46K |
| D0330 |
Panoramic radiographic image |
590 |
550 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,829 |
1,552 |
$21K |
| D2330 |
|
213 |
132 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
248 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
341 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
53 |
$6K |
| D1351 |
Sealant - per tooth |
121 |
45 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
112 |
112 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
14 |
$119.31 |