| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,076 |
6,876 |
$187K |
| D1120 |
Prophylaxis - child |
6,785 |
6,533 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,800 |
7,581 |
$149K |
| D1110 |
Prophylaxis - adult |
1,763 |
1,709 |
$65K |
| D1351 |
Sealant - per tooth |
2,986 |
626 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,047 |
994 |
$40K |
| D0330 |
Panoramic radiographic image |
1,015 |
987 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
250 |
65 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,728 |
2,641 |
$27K |
| D9999 |
Unspecified adjunctive procedure, by report |
653 |
640 |
$15K |
| D1999 |
|
1,006 |
935 |
$10K |
| D0274 |
Bitewings - four radiographic images |
652 |
631 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
88 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
98 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
52 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
185 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
219 |
195 |
$4K |
| D1206 |
Topical application of fluoride varnish |
82 |
81 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
170 |
$1K |
| D0240 |
|
116 |
62 |
$944.46 |
| D0602 |
|
396 |
376 |
$0.00 |
| D0603 |
|
419 |
403 |
$0.00 |
| D0601 |
|
128 |
127 |
$0.00 |