| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,951 |
5,692 |
$145K |
| D1120 |
Prophylaxis - child |
3,131 |
3,022 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,841 |
3,690 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,731 |
5,526 |
$123K |
| D1110 |
Prophylaxis - adult |
3,470 |
3,275 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,129 |
509 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,380 |
577 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
5,262 |
4,965 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,034 |
4,169 |
$58K |
| D8670 |
Periodic orthodontic treatment visit |
2,692 |
2,657 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,693 |
1,550 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
753 |
712 |
$38K |
| D0330 |
Panoramic radiographic image |
498 |
459 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
709 |
$35K |
| D7250 |
|
41 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
49 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
62 |
58 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$594.24 |