| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,771 |
14,670 |
$416K |
| D1110 |
Prophylaxis - adult |
7,438 |
7,389 |
$368K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,600 |
3,305 |
$337K |
| D0330 |
Panoramic radiographic image |
3,400 |
3,374 |
$236K |
| D2140 |
|
6,208 |
3,712 |
$204K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,003 |
6,719 |
$196K |
| D1120 |
Prophylaxis - child |
9,670 |
9,586 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,231 |
2,204 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,808 |
16,676 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,530 |
1,125 |
$59K |
| D2160 |
|
435 |
363 |
$41K |
| D2330 |
|
676 |
435 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,897 |
1,858 |
$33K |
| D0274 |
Bitewings - four radiographic images |
10,334 |
10,256 |
$20K |
| D1330 |
|
16,629 |
16,503 |
$16K |
| D0272 |
Bitewings - two radiographic images |
2,776 |
2,752 |
$16K |
| D2331 |
|
196 |
136 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
37 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,787 |
2,729 |
$13K |
| D1351 |
Sealant - per tooth |
1,699 |
497 |
$12K |
| D2332 |
|
144 |
90 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
357 |
356 |
$8K |
| D2335 |
|
25 |
14 |
$5K |
| D1999 |
|
36 |
36 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
63 |
63 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
141 |
$120.60 |