| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,214 |
12,445 |
$336K |
| D1120 |
Prophylaxis - child |
9,807 |
9,211 |
$258K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,293 |
1,487 |
$242K |
| D1206 |
Topical application of fluoride varnish |
12,489 |
11,714 |
$195K |
| D1110 |
Prophylaxis - adult |
4,213 |
3,934 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
8,136 |
7,568 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,666 |
6,888 |
$99K |
| D0272 |
Bitewings - two radiographic images |
4,698 |
4,396 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
750 |
513 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,225 |
2,064 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
868 |
780 |
$37K |
| D0330 |
Panoramic radiographic image |
636 |
586 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
413 |
368 |
$16K |
| D1351 |
Sealant - per tooth |
657 |
170 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
264 |
244 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$1K |
| D0270 |
|
26 |
25 |
$11.87 |
| D1999 |
|
932 |
872 |
$0.00 |