| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,887 |
4,864 |
$287K |
| D1120 |
Prophylaxis - child |
5,340 |
5,328 |
$209K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,752 |
5,761 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,449 |
6,422 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,264 |
1,263 |
$77K |
| D1351 |
Sealant - per tooth |
1,981 |
671 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,045 |
524 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
777 |
458 |
$52K |
| D0272 |
Bitewings - two radiographic images |
4,019 |
4,010 |
$47K |
| D1310 |
|
922 |
918 |
$41K |
| D9993 |
|
554 |
553 |
$34K |
| D1110 |
Prophylaxis - adult |
392 |
392 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
334 |
333 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
350 |
327 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
100 |
$10K |
| D0350 |
|
825 |
355 |
$8K |
| D0603 |
|
352 |
351 |
$5K |
| D9430 |
|
104 |
98 |
$3K |
| D4910 |
|
38 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
166 |
$2K |
| D2140 |
|
28 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$873.60 |
| D0602 |
|
12 |
12 |
$180.00 |