| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,140 |
12,375 |
$243K |
| D1120 |
Prophylaxis - child |
8,254 |
7,781 |
$225K |
| D1206 |
Topical application of fluoride varnish |
14,264 |
13,446 |
$216K |
| D1110 |
Prophylaxis - adult |
5,866 |
5,515 |
$198K |
| D0274 |
Bitewings - four radiographic images |
4,339 |
4,073 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
631 |
245 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,307 |
1,246 |
$25K |
| D0330 |
Panoramic radiographic image |
409 |
392 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
599 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
879 |
781 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
186 |
$2K |
| D2140 |
|
17 |
12 |
$953.73 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$754.70 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$310.88 |