| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,117 |
6,006 |
$161K |
| D1120 |
Prophylaxis - child |
4,315 |
4,208 |
$118K |
| D1206 |
Topical application of fluoride varnish |
6,415 |
6,268 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
784 |
505 |
$84K |
| D1110 |
Prophylaxis - adult |
2,122 |
2,084 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,856 |
1,683 |
$81K |
| D0272 |
Bitewings - two radiographic images |
1,986 |
1,938 |
$36K |
| D1351 |
Sealant - per tooth |
954 |
350 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
406 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
126 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
54 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$3K |
| D0274 |
Bitewings - four radiographic images |
65 |
64 |
$2K |
| D0240 |
|
70 |
38 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$988.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
13 |
$282.87 |