| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,372 |
1,319 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
341 |
$54K |
| D0330 |
Panoramic radiographic image |
262 |
261 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
58 |
$6K |
| D2335 |
|
53 |
29 |
$6K |
| D1110 |
Prophylaxis - adult |
431 |
423 |
$5K |
| D1354 |
|
14,859 |
1,415 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
632 |
$2K |
| D1330 |
|
1,829 |
1,763 |
$2K |
| D1351 |
Sealant - per tooth |
1,431 |
324 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
13 |
$932.72 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
13 |
$577.38 |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
91 |
$241.52 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,837 |
1,772 |
$74.32 |
| D1120 |
Prophylaxis - child |
1,315 |
1,258 |
$20.81 |
| D0272 |
Bitewings - two radiographic images |
1,572 |
1,525 |
$13.38 |
| D0230 |
Intraoral - periapical each additional radiographic image |
658 |
629 |
$4.46 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
169 |
154 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$0.00 |
| D0240 |
|
1,836 |
1,171 |
$0.00 |