| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,440 |
2,410 |
$103K |
| D1120 |
Prophylaxis - child |
1,925 |
1,906 |
$80K |
| D1206 |
Topical application of fluoride varnish |
1,664 |
1,644 |
$53K |
| D1110 |
Prophylaxis - adult |
743 |
731 |
$43K |
| D0272 |
Bitewings - two radiographic images |
945 |
935 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
382 |
201 |
$32K |
| D1330 |
|
873 |
859 |
$31K |
| D1351 |
Sealant - per tooth |
695 |
211 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
790 |
784 |
$23K |
| D1354 |
|
591 |
163 |
$16K |
| D0330 |
Panoramic radiographic image |
138 |
135 |
$14K |
| D0274 |
Bitewings - four radiographic images |
266 |
263 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
490 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
155 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
465 |
416 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
27 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
331 |
302 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
57 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$2K |
| D1310 |
|
25 |
21 |
$0.00 |