| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,472 |
11,426 |
$669K |
| D1120 |
Prophylaxis - child |
15,858 |
15,748 |
$652K |
| D1310 |
|
4,670 |
4,645 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,570 |
12,471 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,986 |
14,705 |
$131K |
| D0272 |
Bitewings - two radiographic images |
10,875 |
10,812 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,862 |
1,850 |
$119K |
| D1351 |
Sealant - per tooth |
2,503 |
849 |
$72K |
| D0603 |
|
4,165 |
4,143 |
$60K |
| D9993 |
|
1,017 |
1,017 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
816 |
496 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,344 |
1,254 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
400 |
395 |
$26K |
| D0274 |
Bitewings - four radiographic images |
898 |
898 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,536 |
$19K |
| D9430 |
|
489 |
484 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
131 |
67 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
86 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
71 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
576 |
571 |
$6K |
| D0350 |
|
230 |
127 |
$2K |
| D0602 |
|
78 |
78 |
$1K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$510.00 |