| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,117 |
6,099 |
$372K |
| D1120 |
Prophylaxis - child |
9,102 |
9,076 |
$363K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,730 |
8,705 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,142 |
7,710 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,732 |
4,717 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
697 |
432 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
601 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
971 |
921 |
$38K |
| D1310 |
|
472 |
472 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,330 |
1,290 |
$16K |
| D1351 |
Sealant - per tooth |
409 |
147 |
$13K |
| D0274 |
Bitewings - four radiographic images |
529 |
529 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
116 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
174 |
$7K |
| D0603 |
|
351 |
350 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
75 |
40 |
$5K |
| D9248 |
|
55 |
54 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1999 |
|
15 |
15 |
$0.00 |