| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,161 |
4,147 |
$249K |
| D1120 |
Prophylaxis - child |
5,179 |
5,156 |
$208K |
| D1206 |
Topical application of fluoride varnish |
5,157 |
5,126 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,333 |
4,223 |
$60K |
| D1310 |
|
996 |
990 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,425 |
1,419 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
210 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,664 |
1,654 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
472 |
440 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
54 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
145 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
118 |
$8K |
| D0270 |
|
1,495 |
1,473 |
$7K |
| D1351 |
Sealant - per tooth |
234 |
93 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
89 |
$5K |
| D0603 |
|
544 |
544 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
342 |
337 |
$4K |
| D0350 |
|
349 |
234 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
15 |
$1K |
| D0601 |
|
37 |
37 |
$540.00 |