| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,764 |
5,656 |
$260K |
| D1110 |
Prophylaxis - adult |
2,270 |
2,235 |
$127K |
| D1120 |
Prophylaxis - child |
4,965 |
4,862 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,097 |
758 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,462 |
1,438 |
$60K |
| D0330 |
Panoramic radiographic image |
574 |
562 |
$46K |
| D9920 |
|
418 |
361 |
$25K |
| D1999 |
|
319 |
310 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
522 |
406 |
$23K |
| D1351 |
Sealant - per tooth |
1,823 |
518 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$7K |
| D0350 |
|
1,204 |
1,128 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
208 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
102 |
102 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,564 |
3,981 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
131 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,151 |
2,120 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
4,303 |
4,213 |
$932.17 |
| D0272 |
Bitewings - two radiographic images |
3,888 |
3,809 |
$778.34 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$559.34 |
| D1208 |
Topical application of fluoride, excluding varnish |
6,762 |
6,633 |
$454.33 |
| D1330 |
|
7,278 |
7,138 |
$166.95 |
| D3120 |
|
90 |
72 |
$46.00 |
| D1206 |
Topical application of fluoride varnish |
323 |
319 |
$26.42 |
| D1310 |
|
494 |
484 |
$0.00 |
| D9987 |
|
130 |
106 |
$0.00 |
| D9986 |
|
530 |
431 |
$0.00 |