| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,091 |
10,737 |
$486K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,301 |
10,591 |
$234K |
| D1110 |
Prophylaxis - adult |
2,662 |
2,596 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,713 |
1,110 |
$138K |
| D0330 |
Panoramic radiographic image |
1,309 |
1,240 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
310 |
177 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
259 |
$13K |
| D1351 |
Sealant - per tooth |
1,645 |
479 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
381 |
357 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
39 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
12 |
$4K |
| D1120 |
Prophylaxis - child |
8,928 |
8,631 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,099 |
1,920 |
$3K |
| D1206 |
Topical application of fluoride varnish |
10,834 |
10,494 |
$2K |
| D0272 |
Bitewings - two radiographic images |
5,121 |
4,955 |
$865.25 |
| D0220 |
Intraoral - periapical first radiographic image |
11,514 |
11,104 |
$801.06 |
| D1330 |
|
11,018 |
10,657 |
$237.71 |
| D0274 |
Bitewings - four radiographic images |
2,556 |
2,481 |
$139.19 |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
90 |
$0.00 |