| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,569 |
3,552 |
$222K |
| D1120 |
Prophylaxis - child |
5,169 |
5,147 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,653 |
1,643 |
$109K |
| D1310 |
|
1,903 |
1,894 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,812 |
4,788 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,249 |
5,493 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,946 |
3,926 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,089 |
1,011 |
$43K |
| D9993 |
|
726 |
725 |
$43K |
| D1351 |
Sealant - per tooth |
1,353 |
445 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
480 |
224 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
256 |
256 |
$15K |
| D0274 |
Bitewings - four radiographic images |
611 |
608 |
$13K |
| D0603 |
|
775 |
775 |
$11K |
| D0601 |
|
620 |
619 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
671 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
41 |
$3K |
| D9430 |
|
92 |
83 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
15 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$2K |
| D3240 |
|
19 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$928.20 |
| D0602 |
|
18 |
18 |
$270.00 |
| D1999 |
|
12 |
12 |
$0.00 |