| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,116 |
4,080 |
$181K |
| D1110 |
Prophylaxis - adult |
1,912 |
1,899 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,741 |
896 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
5,449 |
5,410 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,293 |
5,253 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
728 |
445 |
$25K |
| D1330 |
|
6,035 |
5,986 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
362 |
357 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,570 |
3,495 |
$17K |
| D0330 |
Panoramic radiographic image |
256 |
254 |
$13K |
| D1351 |
Sealant - per tooth |
1,142 |
301 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
521 |
490 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
695 |
679 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,245 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
265 |
158 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
77 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,564 |
1,551 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,358 |
3,155 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$725.00 |
| D9420 |
|
12 |
12 |
$672.95 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$550.30 |
| D1999 |
|
42 |
40 |
$0.00 |