| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,564 |
4,530 |
$352K |
| D1351 |
Sealant - per tooth |
4,518 |
1,004 |
$108K |
| D1120 |
Prophylaxis - child |
4,664 |
4,632 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,048 |
608 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
3,256 |
3,225 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
400 |
397 |
$39K |
| D2140 |
|
512 |
355 |
$28K |
| D1206 |
Topical application of fluoride varnish |
4,749 |
4,712 |
$14K |
| D0272 |
Bitewings - two radiographic images |
2,370 |
2,350 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,985 |
2,899 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
40 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$991.65 |
| D0330 |
Panoramic radiographic image |
200 |
200 |
$925.25 |
| D0274 |
Bitewings - four radiographic images |
575 |
563 |
$656.81 |
| D1110 |
Prophylaxis - adult |
58 |
57 |
$275.87 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$0.00 |
| D0240 |
|
51 |
26 |
$0.00 |