| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,408 |
4,402 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,887 |
1,014 |
$116K |
| D1120 |
Prophylaxis - child |
2,255 |
2,247 |
$87K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,704 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,856 |
2,853 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,859 |
1,855 |
$46K |
| D4910 |
|
627 |
627 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,933 |
1,928 |
$35K |
| D2140 |
|
497 |
375 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
713 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,307 |
1,247 |
$16K |
| D1351 |
Sealant - per tooth |
398 |
172 |
$12K |
| D0272 |
Bitewings - two radiographic images |
275 |
274 |
$5K |
| D1999 |
|
432 |
394 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
72 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D1354 |
|
373 |
230 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
134 |
$1K |
| D0330 |
Panoramic radiographic image |
38 |
37 |
$832.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$638.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$338.00 |
| D1320 |
|
12 |
12 |
$120.00 |
| D1330 |
|
398 |
395 |
$50.00 |