| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,365 |
7,270 |
$598K |
| D1120 |
Prophylaxis - child |
5,972 |
5,888 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,908 |
7,778 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,351 |
3,308 |
$56K |
| D1110 |
Prophylaxis - adult |
2,114 |
2,080 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,929 |
3,872 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
650 |
359 |
$52K |
| D1206 |
Topical application of fluoride varnish |
5,873 |
5,778 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,578 |
7,464 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
389 |
$35K |
| D0330 |
Panoramic radiographic image |
737 |
724 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
325 |
187 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
141 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
51 |
$4K |
| D1351 |
Sealant - per tooth |
99 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
52 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
40 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
55 |
$0.00 |