| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,966 |
3,935 |
$215K |
| D1120 |
Prophylaxis - child |
4,617 |
4,581 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,648 |
4,615 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,678 |
3,972 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,673 |
1,662 |
$35K |
| D9993 |
|
589 |
589 |
$35K |
| D1310 |
|
1,255 |
1,249 |
$31K |
| D1351 |
Sealant - per tooth |
730 |
193 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
190 |
$19K |
| D0603 |
|
1,179 |
1,173 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,322 |
1,246 |
$16K |
| D9430 |
|
442 |
403 |
$14K |
| D0272 |
Bitewings - two radiographic images |
914 |
907 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
176 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D1999 |
|
30 |
30 |
$92.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
97 |
91 |
$92.00 |