| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,441 |
7,309 |
$155K |
| D1120 |
Prophylaxis - child |
5,124 |
5,042 |
$152K |
| D0330 |
Panoramic radiographic image |
2,640 |
2,601 |
$131K |
| D1110 |
Prophylaxis - adult |
2,758 |
2,701 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,637 |
3,518 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,187 |
7,082 |
$107K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
772 |
474 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,079 |
577 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,042 |
1,962 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,708 |
1,701 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,345 |
2,313 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,427 |
2,389 |
$36K |
| D5110 |
|
41 |
41 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
815 |
757 |
$22K |
| D2140 |
|
246 |
162 |
$14K |
| D0602 |
|
1,519 |
1,472 |
$14K |
| D0603 |
|
1,129 |
1,114 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
13 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
79 |
12 |
$7K |
| D2330 |
|
104 |
76 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
39 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
36 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
121 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
17 |
$1K |
| D0601 |
|
35 |
35 |
$311.10 |