| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,520 |
12,395 |
$328K |
| D1120 |
Prophylaxis - child |
12,832 |
11,776 |
$327K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,164 |
5,383 |
$257K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,966 |
14,689 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,374 |
1,377 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,516 |
931 |
$115K |
| D1110 |
Prophylaxis - adult |
2,328 |
2,092 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,713 |
1,589 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,884 |
3,519 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,609 |
4,138 |
$65K |
| D0240 |
|
3,898 |
1,739 |
$57K |
| D1351 |
Sealant - per tooth |
1,883 |
489 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
961 |
865 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
431 |
265 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,263 |
1,119 |
$26K |
| D0274 |
Bitewings - four radiographic images |
719 |
635 |
$21K |
| D0330 |
Panoramic radiographic image |
278 |
241 |
$13K |
| D0170 |
|
225 |
211 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
24 |
$5K |
| D9995 |
|
58 |
44 |
$2K |
| D9110 |
|
22 |
18 |
$883.06 |
| D1330 |
|
25 |
25 |
$0.00 |
| D1310 |
|
27 |
27 |
$0.00 |