| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
23,927 |
23,800 |
$739K |
| D1206 |
Topical application of fluoride varnish |
21,940 |
21,814 |
$534K |
| D1120 |
Prophylaxis - child |
17,959 |
17,864 |
$530K |
| D0272 |
Bitewings - two radiographic images |
11,391 |
11,320 |
$281K |
| D1110 |
Prophylaxis - adult |
5,259 |
5,230 |
$229K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,099 |
688 |
$114K |
| D1351 |
Sealant - per tooth |
4,478 |
1,206 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,628 |
1,019 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,747 |
2,730 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,533 |
6,130 |
$93K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,548 |
1,021 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,046 |
659 |
$80K |
| D0330 |
Panoramic radiographic image |
663 |
662 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,013 |
1,998 |
$28K |
| D2140 |
|
686 |
519 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
221 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
502 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
674 |
673 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
770 |
740 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,791 |
1,781 |
$4K |
| D2330 |
|
15 |
14 |
$453.95 |
| D1354 |
|
12 |
12 |
$281.82 |
| D9985 |
|
34 |
34 |
$2.40 |