| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,422 |
8,403 |
$200K |
| D1120 |
Prophylaxis - child |
5,309 |
5,306 |
$176K |
| D1206 |
Topical application of fluoride varnish |
8,935 |
8,921 |
$169K |
| D1110 |
Prophylaxis - adult |
3,427 |
3,420 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
6,681 |
6,652 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,860 |
5,843 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,177 |
2,171 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,403 |
1,348 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
211 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,204 |
1,200 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
399 |
397 |
$17K |
| D1351 |
Sealant - per tooth |
454 |
130 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
372 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
65 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
162 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
40 |
$6K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
69 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$2K |
| D1353 |
|
21 |
13 |
$744.30 |