| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,300 |
9,167 |
$232K |
| D1206 |
Topical application of fluoride varnish |
11,019 |
10,851 |
$185K |
| D1110 |
Prophylaxis - adult |
4,345 |
4,274 |
$163K |
| D1120 |
Prophylaxis - child |
6,505 |
6,431 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,964 |
1,077 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,464 |
859 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,358 |
2,338 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,021 |
514 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,044 |
478 |
$55K |
| D0274 |
Bitewings - four radiographic images |
3,612 |
3,547 |
$48K |
| D0272 |
Bitewings - two radiographic images |
4,237 |
4,165 |
$42K |
| D1351 |
Sealant - per tooth |
1,458 |
373 |
$33K |
| D2140 |
|
459 |
237 |
$24K |
| D0330 |
Panoramic radiographic image |
720 |
704 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,084 |
1,064 |
$22K |
| D1999 |
|
1,713 |
1,504 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
194 |
52 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,172 |
2,116 |
$18K |
| D2160 |
|
89 |
41 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
339 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
146 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
28 |
$600.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$424.71 |