| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,019 |
10,947 |
$618K |
| D1120 |
Prophylaxis - child |
12,542 |
12,415 |
$496K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,480 |
2,070 |
$224K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,321 |
12,194 |
$160K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,132 |
3,574 |
$159K |
| D1351 |
Sealant - per tooth |
4,204 |
982 |
$132K |
| D0272 |
Bitewings - two radiographic images |
5,538 |
5,498 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
985 |
639 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,911 |
6,002 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
701 |
699 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
473 |
346 |
$25K |
| D9430 |
|
885 |
816 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
278 |
215 |
$21K |
| D1310 |
|
1,111 |
1,108 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
845 |
$10K |
| D0601 |
|
1,478 |
1,459 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
87 |
$5K |
| D0603 |
|
270 |
268 |
$1K |
| D0602 |
|
77 |
77 |
$825.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |
| D1999 |
|
335 |
335 |
$0.00 |