| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,994 |
4,919 |
$466K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
929 |
915 |
$118K |
| D1120 |
Prophylaxis - child |
5,599 |
5,514 |
$68K |
| D0272 |
Bitewings - two radiographic images |
4,044 |
3,971 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
333 |
306 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,161 |
687 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
220 |
$36K |
| D1351 |
Sealant - per tooth |
1,213 |
284 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,212 |
5,125 |
$31K |
| D1206 |
Topical application of fluoride varnish |
5,466 |
5,386 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,311 |
4,808 |
$20K |
| D0274 |
Bitewings - four radiographic images |
539 |
536 |
$9K |
| D2140 |
|
246 |
161 |
$7K |
| D0330 |
Panoramic radiographic image |
263 |
261 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
117 |
39 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
49 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$367.59 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$0.00 |