| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,871 |
3,835 |
$358K |
| D1351 |
Sealant - per tooth |
2,803 |
447 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
584 |
564 |
$73K |
| D1120 |
Prophylaxis - child |
4,150 |
4,100 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
325 |
301 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,995 |
2,962 |
$33K |
| D1206 |
Topical application of fluoride varnish |
4,204 |
4,153 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
701 |
430 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
4,031 |
3,977 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
145 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,085 |
3,750 |
$16K |
| D0330 |
Panoramic radiographic image |
187 |
185 |
$6K |
| D0274 |
Bitewings - four radiographic images |
269 |
264 |
$6K |
| D2140 |
|
135 |
93 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$900.68 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$121.29 |