| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24,103 |
23,496 |
$628K |
| D1120 |
Prophylaxis - child |
16,462 |
16,060 |
$558K |
| D1110 |
Prophylaxis - adult |
10,040 |
9,818 |
$473K |
| D0272 |
Bitewings - two radiographic images |
19,711 |
19,263 |
$422K |
| D1206 |
Topical application of fluoride varnish |
22,798 |
22,189 |
$389K |
| D0220 |
Intraoral - periapical first radiographic image |
18,959 |
18,508 |
$295K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,852 |
18,358 |
$242K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,863 |
1,796 |
$238K |
| D0210 |
Intraoral - complete series of radiographic images |
2,446 |
2,390 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,660 |
1,104 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,900 |
1,371 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,941 |
4,151 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,574 |
3,511 |
$68K |
| D1351 |
Sealant - per tooth |
2,413 |
779 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,161 |
2,090 |
$61K |
| D0330 |
Panoramic radiographic image |
3,002 |
2,900 |
$60K |
| D0603 |
|
22,603 |
22,042 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,374 |
1,328 |
$43K |
| D2140 |
|
529 |
398 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,218 |
1,174 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
342 |
232 |
$26K |
| D0602 |
|
2,699 |
2,627 |
$9K |
| D2331 |
|
36 |
25 |
$3K |
| D0601 |
|
33 |
33 |
$165.00 |