| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,848 |
2,733 |
$153K |
| D1120 |
Prophylaxis - child |
2,112 |
2,011 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
944 |
894 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
182 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
206 |
202 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
223 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
354 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,317 |
$5K |
| D1351 |
Sealant - per tooth |
58 |
52 |
$5K |
| D1110 |
Prophylaxis - adult |
40 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,011 |
957 |
$4K |
| D0274 |
Bitewings - four radiographic images |
439 |
438 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
336 |
$3K |
| D0330 |
Panoramic radiographic image |
237 |
236 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
253 |
252 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$674.10 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
130 |
127 |
$624.00 |
| D1206 |
Topical application of fluoride varnish |
922 |
865 |
$220.80 |
| D0603 |
|
59 |
59 |
$0.00 |
| D0602 |
|
51 |
51 |
$0.00 |