| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,770 |
6,530 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,814 |
1,138 |
$194K |
| D1110 |
Prophylaxis - adult |
3,341 |
3,207 |
$181K |
| D1120 |
Prophylaxis - child |
4,718 |
4,509 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,879 |
7,557 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,416 |
637 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
2,342 |
2,249 |
$106K |
| D1351 |
Sealant - per tooth |
4,013 |
759 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
810 |
571 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,657 |
1,595 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
737 |
648 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
979 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
388 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,386 |
1,293 |
$11K |
| D1330 |
|
374 |
341 |
$9K |
| D1354 |
|
260 |
58 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |
| D9986 |
|
524 |
517 |
$30.00 |
| D9987 |
|
206 |
201 |
$0.00 |
| D0603 |
|
63 |
43 |
$0.00 |