| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,223 |
24,258 |
$645K |
| D1120 |
Prophylaxis - child |
18,383 |
17,739 |
$483K |
| D1206 |
Topical application of fluoride varnish |
27,643 |
26,521 |
$437K |
| D1110 |
Prophylaxis - adult |
9,034 |
8,665 |
$334K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,416 |
4,989 |
$232K |
| D0272 |
Bitewings - two radiographic images |
9,012 |
8,670 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,217 |
715 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,282 |
608 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,924 |
1,842 |
$59K |
| D0330 |
Panoramic radiographic image |
853 |
829 |
$43K |
| D1351 |
Sealant - per tooth |
1,516 |
434 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,027 |
987 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
687 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
233 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,062 |
1,021 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
31 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
24 |
$798.16 |