| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,133 |
10,855 |
$198K |
| D1120 |
Prophylaxis - child |
7,121 |
6,912 |
$191K |
| D1110 |
Prophylaxis - adult |
5,237 |
5,106 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,220 |
10,929 |
$158K |
| D1999 |
|
7,853 |
7,271 |
$147K |
| D0330 |
Panoramic radiographic image |
2,428 |
2,347 |
$110K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,358 |
1,030 |
$75K |
| D2140 |
|
1,484 |
1,198 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,522 |
2,455 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
910 |
623 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,432 |
2,367 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,005 |
1,897 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,502 |
1,430 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
740 |
714 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
38 |
$19K |
| D1351 |
Sealant - per tooth |
731 |
184 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
1,093 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
48 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
59 |
$617.65 |