| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,973 |
12,716 |
$310K |
| D1120 |
Prophylaxis - child |
8,577 |
8,383 |
$283K |
| D1110 |
Prophylaxis - adult |
6,118 |
6,014 |
$259K |
| D1206 |
Topical application of fluoride varnish |
11,244 |
11,003 |
$233K |
| D0274 |
Bitewings - four radiographic images |
6,121 |
5,997 |
$163K |
| D0330 |
Panoramic radiographic image |
2,360 |
2,312 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,985 |
4,889 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,965 |
1,918 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,830 |
2,756 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,948 |
1,907 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
740 |
585 |
$43K |
| D1351 |
Sealant - per tooth |
1,387 |
426 |
$37K |
| D2140 |
|
589 |
473 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,920 |
1,867 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
715 |
696 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
219 |
159 |
$16K |
| D2332 |
|
145 |
88 |
$11K |
| D1354 |
|
1,348 |
482 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
229 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
38 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |