| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,868 |
2,865 |
$150K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,761 |
852 |
$116K |
| D1120 |
Prophylaxis - child |
2,542 |
2,532 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,443 |
1,430 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,738 |
2,786 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,400 |
1,395 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,612 |
1,611 |
$33K |
| D4910 |
|
423 |
423 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,505 |
2,495 |
$28K |
| D1351 |
Sealant - per tooth |
1,159 |
366 |
$28K |
| D0350 |
|
1,583 |
739 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
55 |
$14K |
| D2160 |
|
174 |
102 |
$14K |
| D4341 |
|
117 |
37 |
$8K |
| D2140 |
|
121 |
70 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
133 |
124 |
$5K |
| D0272 |
Bitewings - two radiographic images |
416 |
413 |
$5K |
| D1110 |
Prophylaxis - adult |
51 |
50 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
309 |
$4K |
| D2330 |
|
40 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
180 |
180 |
$3K |
| D9430 |
|
56 |
54 |
$2K |
| D2954 |
|
14 |
12 |
$1K |
| D7111 |
|
20 |
12 |
$1K |