| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,179 |
7,018 |
$2K |
| D1110 |
Prophylaxis - adult |
2,474 |
2,389 |
$1K |
| D1120 |
Prophylaxis - child |
4,822 |
4,736 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,427 |
5,309 |
$928.72 |
| D0274 |
Bitewings - four radiographic images |
2,203 |
2,118 |
$601.89 |
| D0220 |
Intraoral - periapical first radiographic image |
7,379 |
7,168 |
$598.90 |
| D0272 |
Bitewings - two radiographic images |
4,394 |
4,303 |
$524.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,078 |
5,755 |
$257.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,967 |
1,006 |
$78.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
193 |
$68.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
115 |
$33.00 |
| D1351 |
Sealant - per tooth |
230 |
82 |
$25.00 |
| D1206 |
Topical application of fluoride varnish |
1,854 |
1,798 |
$17.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
461 |
428 |
$0.00 |
| D0330 |
Panoramic radiographic image |
194 |
180 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
462 |
145 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
492 |
327 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
92 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
97 |
89 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
56 |
$0.00 |
| D9248 |
|
61 |
51 |
$0.00 |
| D0603 |
|
77 |
75 |
$0.00 |
| D0602 |
|
40 |
40 |
$0.00 |
| D0601 |
|
23 |
23 |
$0.00 |