| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,919 |
5,890 |
$309K |
| D1120 |
Prophylaxis - child |
5,359 |
5,331 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,785 |
7,664 |
$151K |
| D1110 |
Prophylaxis - adult |
1,752 |
1,738 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,055 |
8,004 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,237 |
1,233 |
$75K |
| D0274 |
Bitewings - four radiographic images |
3,268 |
3,253 |
$67K |
| D9430 |
|
1,568 |
1,398 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
602 |
599 |
$27K |
| D1351 |
Sealant - per tooth |
905 |
264 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,195 |
1,190 |
$14K |
| D1310 |
|
299 |
299 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
999 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
322 |
315 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
67 |
$9K |
| D9993 |
|
184 |
184 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
41 |
$4K |
| D0350 |
|
314 |
142 |
$3K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D0603 |
|
50 |
50 |
$720.00 |