| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,253 |
10,022 |
$308K |
| D1110 |
Prophylaxis - adult |
2,870 |
2,838 |
$222K |
| D1120 |
Prophylaxis - child |
10,846 |
10,562 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,322 |
3,258 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,586 |
1,070 |
$105K |
| D1351 |
Sealant - per tooth |
8,616 |
2,300 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,567 |
14,221 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
573 |
438 |
$23K |
| D8660 |
|
223 |
206 |
$15K |
| D0330 |
Panoramic radiographic image |
588 |
573 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
803 |
763 |
$12K |
| D1330 |
|
14,398 |
14,067 |
$10K |
| D0272 |
Bitewings - two radiographic images |
7,436 |
7,284 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
4,255 |
4,150 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
100 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,254 |
3,591 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
87 |
87 |
$5K |
| D0274 |
Bitewings - four radiographic images |
2,591 |
2,579 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
114 |
114 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37 |
29 |
$4K |
| D9920 |
|
58 |
55 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
150 |
109 |
$2K |
| D0601 |
|
472 |
405 |
$2K |
| D0602 |
|
147 |
135 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$1K |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$951.53 |
| D0603 |
|
154 |
152 |
$560.20 |
| D9993 |
|
144 |
144 |
$386.40 |