| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,235 |
5,062 |
$133K |
| D1120 |
Prophylaxis - child |
4,404 |
4,252 |
$120K |
| D1110 |
Prophylaxis - adult |
2,554 |
2,465 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,741 |
5,526 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
851 |
593 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,139 |
2,047 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,671 |
1,608 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,378 |
1,255 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,306 |
1,255 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,582 |
2,440 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,698 |
1,650 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
249 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
130 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
822 |
428 |
$9K |
| D1351 |
Sealant - per tooth |
331 |
68 |
$9K |
| D0240 |
|
347 |
178 |
$6K |
| D0330 |
Panoramic radiographic image |
73 |
69 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
52 |
$4K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$208.32 |
| D0431 |
|
15 |
15 |
$0.00 |