| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,107 |
11,911 |
$457K |
| D1110 |
Prophylaxis - adult |
4,359 |
4,289 |
$274K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,534 |
2,253 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,495 |
3,440 |
$147K |
| D1120 |
Prophylaxis - child |
12,819 |
12,616 |
$128K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
979 |
802 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,333 |
11,790 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,122 |
1,436 |
$90K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,819 |
1,787 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
409 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,513 |
15,269 |
$37K |
| D1351 |
Sealant - per tooth |
9,712 |
2,749 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,126 |
692 |
$25K |
| D0330 |
Panoramic radiographic image |
239 |
227 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,375 |
1,334 |
$15K |
| D1330 |
|
15,260 |
15,020 |
$13K |
| D0274 |
Bitewings - four radiographic images |
6,566 |
6,444 |
$11K |
| D9920 |
|
572 |
540 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
13,832 |
13,593 |
$10K |
| D0272 |
Bitewings - two radiographic images |
3,840 |
3,783 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
179 |
179 |
$4K |
| D1206 |
Topical application of fluoride varnish |
1,494 |
1,468 |
$4K |
| D2950 |
|
16 |
15 |
$2K |
| D0350 |
|
1,469 |
1,438 |
$1K |
| D2330 |
|
23 |
12 |
$742.07 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
42 |
$655.08 |
| D3120 |
|
209 |
166 |
$187.99 |