| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,676 |
5,667 |
$379K |
| D1120 |
Prophylaxis - child |
5,732 |
5,720 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
756 |
431 |
$66K |
| D1351 |
Sealant - per tooth |
1,941 |
376 |
$62K |
| D1206 |
Topical application of fluoride varnish |
5,956 |
5,943 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,861 |
3,851 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,416 |
1,415 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
443 |
315 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
332 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
485 |
270 |
$25K |
| D2140 |
|
300 |
197 |
$15K |
| D0330 |
Panoramic radiographic image |
344 |
344 |
$14K |
| D1110 |
Prophylaxis - adult |
282 |
282 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,145 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
57 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
693 |
673 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$924.50 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$0.00 |