| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,450 |
6,362 |
$117K |
| D1120 |
Prophylaxis - child |
5,849 |
5,778 |
$93K |
| D1206 |
Topical application of fluoride varnish |
7,248 |
7,153 |
$75K |
| D0272 |
Bitewings - two radiographic images |
4,004 |
3,960 |
$44K |
| D1110 |
Prophylaxis - adult |
1,507 |
1,491 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
655 |
416 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
889 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
383 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,442 |
1,424 |
$24K |
| D0330 |
Panoramic radiographic image |
662 |
657 |
$15K |
| D1351 |
Sealant - per tooth |
708 |
169 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
522 |
512 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,341 |
1,322 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,150 |
1,121 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
115 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
321 |
275 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
212 |
212 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$2K |
| D1999 |
|
382 |
348 |
$0.00 |