| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,136 |
4,096 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,139 |
$79K |
| D1120 |
Prophylaxis - child |
5,079 |
5,028 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
605 |
548 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
225 |
$25K |
| D0330 |
Panoramic radiographic image |
114 |
113 |
$11K |
| D1206 |
Topical application of fluoride varnish |
5,248 |
5,196 |
$10K |
| D1330 |
|
5,376 |
5,324 |
$8K |
| D1110 |
Prophylaxis - adult |
93 |
91 |
$7K |
| D1351 |
Sealant - per tooth |
703 |
204 |
$4K |
| D0272 |
Bitewings - two radiographic images |
2,693 |
2,670 |
$4K |
| D0603 |
|
1,715 |
1,708 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,771 |
2,735 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
40 |
$773.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,799 |
1,769 |
$545.48 |
| D0999 |
Unspecified diagnostic procedure, by report |
20 |
20 |
$400.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$126.53 |
| D0240 |
|
742 |
736 |
$58.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |
| D1999 |
|
18 |
18 |
$0.00 |