| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,783 |
3,931 |
$126K |
| D1120 |
Prophylaxis - child |
3,059 |
2,475 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,132 |
3,333 |
$81K |
| D1110 |
Prophylaxis - adult |
1,587 |
1,355 |
$75K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
488 |
277 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,501 |
2,081 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
536 |
369 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,700 |
1,317 |
$43K |
| D1351 |
Sealant - per tooth |
1,519 |
503 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
460 |
328 |
$40K |
| D2140 |
|
518 |
374 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,739 |
1,207 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
299 |
172 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,316 |
893 |
$18K |
| D1206 |
Topical application of fluoride varnish |
453 |
453 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
45 |
$9K |
| D0603 |
|
1,474 |
1,146 |
$5K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
34 |
$4K |
| D0274 |
Bitewings - four radiographic images |
97 |
97 |
$2K |
| D0601 |
|
585 |
487 |
$2K |
| D0602 |
|
569 |
438 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$2K |
| D2160 |
|
14 |
12 |
$1K |
| D1999 |
|
326 |
298 |
$0.00 |