| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,087 |
8,819 |
$248K |
| D1120 |
Prophylaxis - child |
6,876 |
6,685 |
$229K |
| D1110 |
Prophylaxis - adult |
2,735 |
2,669 |
$138K |
| D0145 |
Oral evaluation for a patient under three years of age |
975 |
959 |
$133K |
| D0272 |
Bitewings - two radiographic images |
5,656 |
5,504 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,335 |
10,017 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
8,744 |
8,383 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,501 |
6,920 |
$89K |
| D1351 |
Sealant - per tooth |
3,724 |
1,015 |
$84K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
594 |
222 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,615 |
1,578 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,288 |
1,221 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
493 |
256 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
839 |
792 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
866 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
210 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
83 |
$8K |
| D9248 |
|
29 |
26 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
14 |
$2K |
| D9420 |
|
14 |
13 |
$399.41 |
| D0603 |
|
13,150 |
12,775 |
$0.00 |