| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,483 |
8,991 |
$238K |
| D1120 |
Prophylaxis - child |
6,669 |
6,322 |
$222K |
| D1206 |
Topical application of fluoride varnish |
9,513 |
9,022 |
$174K |
| D0240 |
|
6,056 |
2,847 |
$141K |
| D0272 |
Bitewings - two radiographic images |
5,633 |
5,344 |
$130K |
| D1110 |
Prophylaxis - adult |
2,784 |
2,662 |
$126K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,604 |
681 |
$124K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
625 |
178 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,016 |
482 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,730 |
2,371 |
$65K |
| D0603 |
|
8,769 |
8,384 |
$34K |
| D0330 |
Panoramic radiographic image |
545 |
540 |
$30K |
| D9248 |
|
318 |
293 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,125 |
1,081 |
$18K |
| D1351 |
Sealant - per tooth |
586 |
217 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
845 |
782 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
66 |
$10K |
| D2160 |
|
100 |
52 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
214 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
143 |
$4K |
| D0602 |
|
417 |
379 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$261.70 |
| D9215 |
|
178 |
160 |
$0.00 |