| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,550 |
2,545 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,425 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
934 |
607 |
$70K |
| D1120 |
Prophylaxis - child |
3,289 |
3,281 |
$39K |
| D1110 |
Prophylaxis - adult |
664 |
663 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,194 |
1,046 |
$27K |
| D0330 |
Panoramic radiographic image |
484 |
481 |
$20K |
| D1206 |
Topical application of fluoride varnish |
3,848 |
3,839 |
$20K |
| D9920 |
|
279 |
272 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,547 |
1,472 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
113 |
$14K |
| D1351 |
Sealant - per tooth |
2,143 |
629 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
264 |
$10K |
| D0240 |
|
1,603 |
851 |
$9K |
| D1330 |
|
3,992 |
3,983 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
526 |
513 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,377 |
1,375 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,719 |
1,708 |
$2K |
| D0274 |
Bitewings - four radiographic images |
551 |
551 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
28 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$575.00 |
| D0602 |
|
180 |
180 |
$136.00 |
| D0603 |
|
157 |
157 |
$52.00 |
| D0601 |
|
36 |
36 |
$0.00 |