| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,840 |
8,491 |
$227K |
| D1120 |
Prophylaxis - child |
7,560 |
7,242 |
$198K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,740 |
8,335 |
$142K |
| D1351 |
Sealant - per tooth |
4,731 |
1,231 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,149 |
692 |
$119K |
| D1110 |
Prophylaxis - adult |
2,707 |
2,568 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,292 |
1,999 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,158 |
3,038 |
$54K |
| D0330 |
Panoramic radiographic image |
1,135 |
1,040 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
958 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,236 |
1,137 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,853 |
1,775 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
616 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,134 |
1,104 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
980 |
864 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
103 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
43 |
$5K |
| D0240 |
|
306 |
137 |
$4K |
| D1999 |
|
1,209 |
1,075 |
$0.00 |
| D1310 |
|
82 |
81 |
$0.00 |
| D1330 |
|
81 |
80 |
$0.00 |