| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,763 |
14,204 |
$329K |
| D1110 |
Prophylaxis - adult |
8,215 |
7,850 |
$324K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,941 |
14,393 |
$281K |
| D1120 |
Prophylaxis - child |
8,594 |
8,301 |
$268K |
| D0274 |
Bitewings - four radiographic images |
5,533 |
5,229 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,398 |
4,089 |
$118K |
| D0330 |
Panoramic radiographic image |
1,932 |
1,789 |
$77K |
| D1351 |
Sealant - per tooth |
2,696 |
689 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,246 |
1,171 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
595 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,742 |
1,657 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,650 |
2,569 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
439 |
$32K |
| D1353 |
|
1,216 |
249 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
784 |
307 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
195 |
$5K |
| D1206 |
Topical application of fluoride varnish |
235 |
227 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
147 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
15 |
$320.68 |
| D9999 |
Unspecified adjunctive procedure, by report |
453 |
447 |
$0.00 |