| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,834 |
7,755 |
$520K |
| D1120 |
Prophylaxis - child |
6,244 |
6,179 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
1,285 |
1,254 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,313 |
613 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
380 |
$61K |
| D1110 |
Prophylaxis - adult |
1,208 |
1,193 |
$49K |
| D1206 |
Topical application of fluoride varnish |
6,712 |
6,653 |
$22K |
| D1351 |
Sealant - per tooth |
638 |
202 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
219 |
$21K |
| D0272 |
Bitewings - two radiographic images |
3,146 |
3,111 |
$19K |
| D0330 |
Panoramic radiographic image |
506 |
497 |
$14K |
| D2140 |
|
206 |
113 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
99 |
$9K |
| D0274 |
Bitewings - four radiographic images |
809 |
797 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
87 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
394 |
380 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
305 |
301 |
$574.23 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$535.88 |
| D9248 |
|
27 |
24 |
$435.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
311 |
267 |
$241.30 |
| D1999 |
|
24 |
23 |
$0.00 |