| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,884 |
3,849 |
$221K |
| D1120 |
Prophylaxis - child |
4,264 |
4,230 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,462 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,061 |
5,025 |
$67K |
| D1110 |
Prophylaxis - adult |
623 |
623 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
714 |
676 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,270 |
2,257 |
$27K |
| D0330 |
Panoramic radiographic image |
868 |
858 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
426 |
196 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,506 |
2,809 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
214 |
$21K |
| D9430 |
|
480 |
475 |
$15K |
| D0274 |
Bitewings - four radiographic images |
606 |
598 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
860 |
840 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
108 |
$9K |
| D1351 |
Sealant - per tooth |
298 |
92 |
$7K |
| D1310 |
|
145 |
143 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$2K |
| D1999 |
|
47 |
45 |
$10.00 |