| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,392 |
3,373 |
$68K |
| D1110 |
Prophylaxis - adult |
3,314 |
3,290 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,776 |
1,460 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,829 |
4,390 |
$26K |
| D1120 |
Prophylaxis - child |
1,135 |
1,130 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,017 |
1,013 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
5,072 |
4,990 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,868 |
1,860 |
$19K |
| D2750 |
|
46 |
39 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,633 |
1,627 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
592 |
576 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,864 |
1,848 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
67 |
$4K |
| D2952 |
|
42 |
37 |
$4K |
| D9110 |
|
355 |
342 |
$3K |
| D0330 |
Panoramic radiographic image |
82 |
82 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
14 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
14 |
$1K |