| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17,743 |
17,254 |
$459K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,202 |
2,523 |
$436K |
| D1120 |
Prophylaxis - child |
13,145 |
12,730 |
$355K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,608 |
19,008 |
$324K |
| D1110 |
Prophylaxis - adult |
6,859 |
6,666 |
$261K |
| D1351 |
Sealant - per tooth |
8,662 |
2,317 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,390 |
1,846 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,655 |
1,470 |
$167K |
| D0272 |
Bitewings - two radiographic images |
6,466 |
6,243 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,706 |
3,592 |
$117K |
| D0330 |
Panoramic radiographic image |
2,045 |
1,958 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,518 |
2,147 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,885 |
1,780 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
4,308 |
4,110 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,096 |
2,341 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
910 |
$35K |
| D7111 |
|
222 |
120 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
58 |
$10K |
| D0000 |
|
32 |
31 |
$0.00 |