| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,793 |
1,793 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,920 |
2,836 |
$57K |
| D1120 |
Prophylaxis - child |
1,637 |
1,632 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
681 |
308 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
469 |
469 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,368 |
1,368 |
$16K |
| D0274 |
Bitewings - four radiographic images |
684 |
684 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,572 |
1,568 |
$14K |
| D1110 |
Prophylaxis - adult |
134 |
134 |
$11K |
| D2140 |
|
148 |
73 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
55 |
$7K |
| D9430 |
|
236 |
234 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
52 |
$7K |
| D0350 |
|
335 |
294 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
135 |
126 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
382 |
$4K |
| D1351 |
Sealant - per tooth |
172 |
49 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
25 |
$3K |
| D2160 |
|
26 |
16 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |
| D2330 |
|
22 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$1K |
| D0270 |
|
12 |
12 |
$55.00 |