| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,738 |
4,686 |
$301K |
| D1120 |
Prophylaxis - child |
5,634 |
5,572 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,953 |
6,522 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,475 |
6,389 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,416 |
$93K |
| D1351 |
Sealant - per tooth |
3,026 |
688 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,399 |
661 |
$76K |
| D1110 |
Prophylaxis - adult |
682 |
668 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,138 |
3,985 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
759 |
477 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
563 |
346 |
$37K |
| D9430 |
|
964 |
931 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,996 |
1,968 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,106 |
1,077 |
$23K |
| D1310 |
|
428 |
424 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
158 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
174 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
177 |
$7K |
| D0601 |
|
213 |
212 |
$3K |
| D0603 |
|
54 |
53 |
$735.00 |