| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,167 |
1,839 |
$56K |
| D1120 |
Prophylaxis - child |
1,530 |
1,310 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
398 |
256 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,268 |
1,088 |
$28K |
| D1110 |
Prophylaxis - adult |
542 |
484 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,354 |
1,134 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
95 |
$23K |
| D2140 |
|
323 |
183 |
$21K |
| D1351 |
Sealant - per tooth |
762 |
225 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,150 |
879 |
$18K |
| D1206 |
Topical application of fluoride varnish |
743 |
658 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
150 |
113 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
613 |
478 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
863 |
635 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
74 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
99 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
133 |
$5K |
| D0330 |
Panoramic radiographic image |
90 |
85 |
$5K |
| D0274 |
Bitewings - four radiographic images |
178 |
157 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
26 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
68 |
$3K |
| D0603 |
|
611 |
558 |
$2K |
| D0602 |
|
438 |
349 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$1K |
| D0601 |
|
42 |
40 |
$210.00 |