| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,145 |
5,101 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,128 |
684 |
$105K |
| D1120 |
Prophylaxis - child |
3,481 |
3,457 |
$104K |
| D1110 |
Prophylaxis - adult |
1,962 |
1,945 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,581 |
5,537 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,327 |
2,036 |
$63K |
| D0272 |
Bitewings - two radiographic images |
1,882 |
1,882 |
$34K |
| D2140 |
|
526 |
367 |
$31K |
| D0274 |
Bitewings - four radiographic images |
926 |
926 |
$28K |
| D0330 |
Panoramic radiographic image |
565 |
565 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
635 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
895 |
865 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
82 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
167 |
167 |
$5K |
| D1351 |
Sealant - per tooth |
97 |
38 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
12 |
$144.78 |