| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,699 |
27,309 |
$738K |
| D1120 |
Prophylaxis - child |
26,250 |
25,901 |
$622K |
| D1206 |
Topical application of fluoride varnish |
28,256 |
27,858 |
$551K |
| D9999 |
Unspecified adjunctive procedure, by report |
6,121 |
6,041 |
$176K |
| D1110 |
Prophylaxis - adult |
3,603 |
3,539 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
15,968 |
15,628 |
$129K |
| D0272 |
Bitewings - two radiographic images |
9,025 |
8,857 |
$90K |
| D0330 |
Panoramic radiographic image |
2,112 |
2,089 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,671 |
1,651 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,946 |
2,831 |
$62K |
| D9630 |
|
1,373 |
1,257 |
$57K |
| D1351 |
Sealant - per tooth |
1,937 |
443 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,007 |
1,902 |
$44K |
| D1999 |
|
3,291 |
3,194 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,310 |
13,792 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,162 |
2,135 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
483 |
177 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
72 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
12 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
52 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$899.46 |
| D1354 |
|
295 |
50 |
$885.00 |