| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,103 |
5,005 |
$414K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,461 |
1,413 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
334 |
322 |
$66K |
| D0272 |
Bitewings - two radiographic images |
4,086 |
3,973 |
$56K |
| D1120 |
Prophylaxis - child |
5,393 |
5,272 |
$55K |
| D1206 |
Topical application of fluoride varnish |
5,531 |
5,413 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
134 |
120 |
$17K |
| D2140 |
|
337 |
162 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
391 |
225 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
333 |
94 |
$13K |
| D1351 |
Sealant - per tooth |
225 |
65 |
$9K |
| D1110 |
Prophylaxis - adult |
151 |
149 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
89 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
26 |
$19.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$0.00 |