| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,714 |
5,666 |
$228K |
| D1110 |
Prophylaxis - adult |
2,297 |
2,274 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,943 |
1,056 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,038 |
2,023 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
482 |
241 |
$48K |
| D1120 |
Prophylaxis - child |
5,179 |
5,134 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,905 |
1,814 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,720 |
7,654 |
$20K |
| D0330 |
Panoramic radiographic image |
477 |
475 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
102 |
51 |
$12K |
| D1330 |
|
7,931 |
7,865 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,824 |
7,907 |
$7K |
| D1351 |
Sealant - per tooth |
913 |
297 |
$7K |
| D0274 |
Bitewings - four radiographic images |
3,330 |
3,301 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
8,194 |
8,109 |
$7K |
| D9920 |
|
174 |
157 |
$6K |
| D1999 |
|
321 |
312 |
$5K |
| D0272 |
Bitewings - two radiographic images |
3,303 |
3,281 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
251 |
154 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
91 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
115 |
115 |
$3K |
| D8660 |
|
14 |
14 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$925.45 |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$385.28 |
| D3120 |
|
258 |
110 |
$352.00 |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
106 |
$0.00 |