| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,408 |
1,403 |
$61K |
| D1120 |
Prophylaxis - child |
1,345 |
1,334 |
$41K |
| D0350 |
|
10,073 |
3,242 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,314 |
2,799 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
650 |
$36K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
66 |
39 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
1,003 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,526 |
1,510 |
$16K |
| D2140 |
|
248 |
89 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
185 |
81 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
279 |
278 |
$11K |
| D9430 |
|
241 |
237 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
532 |
518 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
36 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
80 |
$3K |
| D1351 |
Sealant - per tooth |
130 |
46 |
$3K |
| D9310 |
|
57 |
51 |
$2K |
| D2952 |
|
20 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
69 |
68 |
$1K |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$498.00 |
| D1999 |
|
34 |
31 |
$60.00 |