| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,400 |
11,328 |
$641K |
| D1120 |
Prophylaxis - child |
11,730 |
11,655 |
$462K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,822 |
11,746 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,214 |
6,823 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,306 |
1,421 |
$123K |
| D1351 |
Sealant - per tooth |
3,481 |
906 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,290 |
1,286 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,198 |
873 |
$80K |
| D1310 |
|
1,651 |
1,643 |
$75K |
| D1110 |
Prophylaxis - adult |
762 |
754 |
$68K |
| D0272 |
Bitewings - two radiographic images |
5,006 |
4,971 |
$59K |
| D9993 |
|
773 |
772 |
$50K |
| D0350 |
|
3,709 |
2,257 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,245 |
2,207 |
$27K |
| D9430 |
|
701 |
672 |
$22K |
| D1206 |
Topical application of fluoride varnish |
678 |
670 |
$12K |
| D0602 |
|
671 |
668 |
$10K |
| D0603 |
|
452 |
452 |
$7K |
| D0330 |
Panoramic radiographic image |
138 |
138 |
$4K |
| D4341 |
|
45 |
12 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$918.40 |
| D9910 |
|
14 |
14 |
$722.40 |