| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,234 |
12,468 |
$348K |
| D1110 |
Prophylaxis - adult |
6,912 |
6,524 |
$329K |
| D0272 |
Bitewings - two radiographic images |
12,036 |
11,423 |
$257K |
| D1120 |
Prophylaxis - child |
7,499 |
7,183 |
$257K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,336 |
13,587 |
$236K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,029 |
1,000 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
9,710 |
9,389 |
$135K |
| D1351 |
Sealant - per tooth |
4,710 |
746 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,671 |
1,041 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,608 |
8,374 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,660 |
3,326 |
$94K |
| D2140 |
|
1,524 |
810 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,155 |
1,095 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,838 |
1,805 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
317 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,354 |
1,338 |
$42K |
| D0330 |
Panoramic radiographic image |
1,528 |
1,493 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
756 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
134 |
$17K |
| D0602 |
|
5,400 |
5,313 |
$8K |
| D0603 |
|
4,294 |
4,196 |
$6K |
| D0601 |
|
3,238 |
3,167 |
$4K |
| D7111 |
|
52 |
37 |
$1K |
| D0707 |
|
26 |
26 |
$0.00 |