| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,144 |
4,995 |
$131K |
| D0274 |
Bitewings - four radiographic images |
5,309 |
5,163 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,784 |
925 |
$95K |
| D1120 |
Prophylaxis - child |
4,184 |
4,044 |
$92K |
| D1206 |
Topical application of fluoride varnish |
5,755 |
5,587 |
$81K |
| D1351 |
Sealant - per tooth |
3,376 |
1,064 |
$66K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
652 |
262 |
$50K |
| D1110 |
Prophylaxis - adult |
1,541 |
1,517 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,800 |
1,601 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
776 |
347 |
$39K |
| D2140 |
|
922 |
610 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
673 |
$28K |
| D9420 |
|
193 |
193 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
1,036 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
756 |
577 |
$7K |
| D3240 |
|
57 |
40 |
$6K |
| D0350 |
|
203 |
199 |
$5K |
| D2160 |
|
67 |
43 |
$4K |
| D2331 |
|
48 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
52 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$659.00 |