| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,541 |
4,508 |
$266K |
| D1120 |
Prophylaxis - child |
3,903 |
3,881 |
$156K |
| D1110 |
Prophylaxis - adult |
1,734 |
1,723 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,430 |
820 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,847 |
4,403 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,005 |
1,003 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,537 |
4,511 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,890 |
2,878 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
603 |
347 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
501 |
348 |
$29K |
| D1310 |
|
827 |
825 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,153 |
2,113 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,057 |
1,056 |
$18K |
| D4910 |
|
235 |
235 |
$18K |
| D9993 |
|
401 |
400 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
142 |
$7K |
| D4341 |
|
51 |
13 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
51 |
$2K |
| D0603 |
|
143 |
142 |
$2K |
| D1351 |
Sealant - per tooth |
50 |
13 |
$2K |
| D9430 |
|
58 |
56 |
$2K |
| D2330 |
|
22 |
12 |
$2K |
| D1999 |
|
336 |
321 |
$276.00 |
| D0350 |
|
24 |
13 |
$249.60 |
| D0602 |
|
14 |
14 |
$210.00 |
| D1330 |
|
727 |
726 |
$0.00 |