| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,305 |
5,298 |
$289K |
| D1120 |
Prophylaxis - child |
5,890 |
5,879 |
$217K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,643 |
1,723 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,742 |
2,738 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,565 |
7,434 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,173 |
6,151 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,006 |
3,005 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,296 |
1,292 |
$61K |
| D1351 |
Sealant - per tooth |
1,433 |
395 |
$45K |
| D1310 |
|
861 |
859 |
$38K |
| D1110 |
Prophylaxis - adult |
503 |
500 |
$36K |
| D9993 |
|
582 |
581 |
$36K |
| D2140 |
|
624 |
465 |
$34K |
| D9430 |
|
961 |
921 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,454 |
2,450 |
$29K |
| D2160 |
|
247 |
193 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
306 |
179 |
$17K |
| D0350 |
|
1,573 |
1,089 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
17 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
883 |
874 |
$10K |
| D0270 |
|
1,348 |
1,201 |
$7K |
| D1206 |
Topical application of fluoride varnish |
235 |
235 |
$4K |
| D0602 |
|
69 |
69 |
$1K |
| D0601 |
|
46 |
46 |
$656.25 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$640.00 |
| D0603 |
|
24 |
24 |
$360.00 |