| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,170 |
$62K |
| D1110 |
Prophylaxis - adult |
447 |
442 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,258 |
1,253 |
$32K |
| D8660 |
|
341 |
322 |
$25K |
| D1120 |
Prophylaxis - child |
2,000 |
1,963 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
187 |
$21K |
| D8670 |
Periodic orthodontic treatment visit |
269 |
268 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
169 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,104 |
3,058 |
$9K |
| D1330 |
|
3,076 |
3,024 |
$3K |
| D1351 |
Sealant - per tooth |
1,625 |
388 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,298 |
1,292 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
109 |
$3K |
| D0330 |
Panoramic radiographic image |
130 |
119 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
107 |
107 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,415 |
1,389 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,217 |
1,104 |
$997.08 |
| D9920 |
|
59 |
43 |
$888.70 |
| D0274 |
Bitewings - four radiographic images |
370 |
368 |
$670.40 |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
28 |
$460.00 |
| D3120 |
|
32 |
26 |
$95.35 |
| D0601 |
|
71 |
59 |
$34.00 |
| D0603 |
|
31 |
31 |
$6.00 |