| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,118 |
4,759 |
$138K |
| D1120 |
Prophylaxis - child |
4,811 |
4,193 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,213 |
2,540 |
$109K |
| D1110 |
Prophylaxis - adult |
2,673 |
2,397 |
$100K |
| D1351 |
Sealant - per tooth |
4,510 |
985 |
$97K |
| D1206 |
Topical application of fluoride varnish |
5,825 |
5,122 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,333 |
600 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
682 |
473 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,619 |
1,436 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
763 |
446 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,126 |
2,784 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,217 |
1,062 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,727 |
1,502 |
$30K |
| 99199 |
Unlisted special service, procedure or report |
4,548 |
4,088 |
$23K |
| D0330 |
Panoramic radiographic image |
304 |
292 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,514 |
1,001 |
$16K |
| D1354 |
|
873 |
337 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
302 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
65 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
58 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
12 |
$2K |
| D9996 |
|
211 |
204 |
$0.00 |
| D0603 |
|
592 |
514 |
$0.00 |
| D1330 |
|
771 |
634 |
$0.00 |
| D1310 |
|
815 |
667 |
$0.00 |
| D0602 |
|
427 |
347 |
$0.00 |