| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,724 |
19,450 |
$502K |
| D1110 |
Prophylaxis - adult |
8,387 |
8,281 |
$379K |
| D1120 |
Prophylaxis - child |
11,295 |
11,137 |
$375K |
| D1206 |
Topical application of fluoride varnish |
18,147 |
17,906 |
$348K |
| D0272 |
Bitewings - two radiographic images |
9,473 |
9,351 |
$215K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,042 |
366 |
$141K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,714 |
4,538 |
$115K |
| D0603 |
|
9,806 |
9,660 |
$39K |
| D0602 |
|
6,826 |
6,700 |
$26K |
| D1351 |
Sealant - per tooth |
715 |
202 |
$19K |
| D9248 |
|
161 |
158 |
$15K |
| D0330 |
Panoramic radiographic image |
316 |
311 |
$15K |
| D0601 |
|
2,970 |
2,935 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
612 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
308 |
302 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
56 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
43 |
$4K |
| D2140 |
|
69 |
51 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$342.00 |