| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,580 |
2,504 |
$69K |
| D1110 |
Prophylaxis - adult |
1,246 |
1,221 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,860 |
1,808 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
242 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,284 |
3,210 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,445 |
3,023 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,919 |
1,898 |
$27K |
| D1120 |
Prophylaxis - child |
631 |
622 |
$22K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
203 |
32 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
269 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
78 |
$9K |
| D0272 |
Bitewings - two radiographic images |
356 |
352 |
$8K |
| D0330 |
Panoramic radiographic image |
169 |
168 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
105 |
$3K |
| D9222 |
|
36 |
32 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$244.27 |
| D0603 |
|
2,158 |
2,135 |
$0.00 |
| D0601 |
|
1,020 |
1,016 |
$0.00 |
| D0602 |
|
225 |
222 |
$0.00 |