| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,231 |
15,970 |
$439K |
| D1120 |
Prophylaxis - child |
15,793 |
15,538 |
$375K |
| D1206 |
Topical application of fluoride varnish |
17,072 |
16,784 |
$339K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,414 |
3,353 |
$104K |
| D1110 |
Prophylaxis - adult |
1,883 |
1,846 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
9,267 |
9,054 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
1,328 |
$53K |
| D0272 |
Bitewings - two radiographic images |
4,955 |
4,871 |
$50K |
| D1999 |
|
2,005 |
1,945 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,117 |
7,770 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
808 |
753 |
$19K |
| D9630 |
|
421 |
394 |
$18K |
| D1351 |
Sealant - per tooth |
727 |
136 |
$18K |
| D0274 |
Bitewings - four radiographic images |
932 |
909 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
380 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
53 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
65 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$1K |