| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
4,585 |
3,955 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,645 |
1,644 |
$72K |
| D1120 |
Prophylaxis - child |
1,917 |
1,912 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
850 |
848 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,558 |
$33K |
| D1110 |
Prophylaxis - adult |
321 |
320 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,127 |
2,121 |
$18K |
| D9430 |
|
413 |
402 |
$13K |
| D0272 |
Bitewings - two radiographic images |
771 |
771 |
$9K |
| D1351 |
Sealant - per tooth |
363 |
100 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
38 |
$5K |
| D1206 |
Topical application of fluoride varnish |
238 |
238 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
12 |
$3K |
| D9993 |
|
41 |
41 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
203 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
67 |
$3K |
| D0350 |
|
155 |
139 |
$2K |
| D4341 |
|
46 |
13 |
$2K |
| D1310 |
|
41 |
41 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |