| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,834 |
4,817 |
$288K |
| D1120 |
Prophylaxis - child |
6,961 |
6,940 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,185 |
1,003 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,549 |
1,548 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,877 |
6,854 |
$96K |
| D1310 |
|
1,589 |
1,580 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,714 |
2,954 |
$47K |
| D1351 |
Sealant - per tooth |
1,500 |
423 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
776 |
412 |
$43K |
| D9993 |
|
473 |
472 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,381 |
2,321 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
667 |
637 |
$26K |
| D0603 |
|
1,500 |
1,492 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
238 |
151 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
172 |
$12K |
| D0274 |
Bitewings - four radiographic images |
545 |
542 |
$11K |
| D9430 |
|
353 |
341 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
65 |
$7K |
| D0350 |
|
662 |
383 |
$7K |
| D2335 |
|
33 |
12 |
$4K |
| D9248 |
|
71 |
71 |
$2K |
| D0272 |
Bitewings - two radiographic images |
52 |
52 |
$576.00 |
| D0602 |
|
14 |
14 |
$195.00 |