| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,159 |
7,999 |
$234K |
| D1120 |
Prophylaxis - child |
8,533 |
8,380 |
$209K |
| D1206 |
Topical application of fluoride varnish |
8,488 |
8,346 |
$183K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,011 |
1,979 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,085 |
4,906 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
367 |
59 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
636 |
211 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
736 |
727 |
$32K |
| D0272 |
Bitewings - two radiographic images |
3,005 |
2,894 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,067 |
979 |
$22K |
| D1110 |
Prophylaxis - adult |
421 |
413 |
$18K |
| D9630 |
|
331 |
294 |
$13K |
| D1999 |
|
986 |
950 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,413 |
4,213 |
$11K |
| D0330 |
Panoramic radiographic image |
160 |
158 |
$6K |
| D1351 |
Sealant - per tooth |
272 |
68 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
208 |
$5K |
| D0274 |
Bitewings - four radiographic images |
184 |
180 |
$3K |