| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,043 |
6,015 |
$342K |
| D1120 |
Prophylaxis - child |
7,082 |
7,042 |
$281K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,442 |
1,399 |
$159K |
| D1206 |
Topical application of fluoride varnish |
6,945 |
6,913 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,505 |
1,044 |
$77K |
| D1351 |
Sealant - per tooth |
2,255 |
694 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,066 |
3,057 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,880 |
6,090 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,572 |
1,474 |
$61K |
| D9993 |
|
1,752 |
1,747 |
$44K |
| D1310 |
|
1,777 |
1,770 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,145 |
2,070 |
$25K |
| D0350 |
|
2,268 |
1,439 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
323 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,424 |
1,416 |
$16K |
| D0603 |
|
1,000 |
997 |
$15K |
| D9430 |
|
232 |
225 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$3K |
| D0602 |
|
91 |
91 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$918.40 |
| D0601 |
|
14 |
14 |
$210.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
29 |
$198.08 |