| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,840 |
1,693 |
$75K |
| D1120 |
Prophylaxis - child |
3,724 |
3,508 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,490 |
2,388 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
348 |
185 |
$21K |
| D1110 |
Prophylaxis - adult |
447 |
437 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,826 |
3,600 |
$14K |
| D1351 |
Sealant - per tooth |
1,667 |
405 |
$9K |
| D0274 |
Bitewings - four radiographic images |
778 |
754 |
$9K |
| D1330 |
|
3,973 |
3,805 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,755 |
1,645 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
126 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
625 |
565 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
505 |
435 |
$6K |
| D9920 |
|
79 |
79 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,982 |
1,827 |
$2K |
| D0330 |
Panoramic radiographic image |
145 |
125 |
$2K |
| D9310 |
|
211 |
158 |
$1K |
| D0340 |
|
18 |
16 |
$1K |
| D0601 |
|
359 |
357 |
$650.00 |
| D0272 |
Bitewings - two radiographic images |
91 |
79 |
$105.00 |
| D0603 |
|
102 |
100 |
$15.00 |