| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,905 |
4,903 |
$241K |
| D1120 |
Prophylaxis - child |
4,683 |
4,681 |
$147K |
| D1351 |
Sealant - per tooth |
4,232 |
923 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,762 |
4,762 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,052 |
4,029 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
312 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,940 |
1,939 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,849 |
3,749 |
$34K |
| D0330 |
Panoramic radiographic image |
604 |
604 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,066 |
1,066 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
286 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
216 |
136 |
$15K |
| D1110 |
Prophylaxis - adult |
269 |
269 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
103 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
40 |
$4K |
| D2140 |
|
55 |
40 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
92 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$0.00 |