| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,666 |
2,043 |
$107K |
| D9920 |
|
756 |
666 |
$76K |
| D0240 |
|
4,423 |
3,211 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,036 |
990 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,876 |
2,730 |
$46K |
| D1110 |
Prophylaxis - adult |
600 |
573 |
$26K |
| D0330 |
Panoramic radiographic image |
459 |
436 |
$21K |
| D1354 |
|
13,275 |
1,151 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
27 |
$10K |
| D9110 |
|
251 |
216 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
112 |
$9K |
| D1120 |
Prophylaxis - child |
3,248 |
3,083 |
$9K |
| D1351 |
Sealant - per tooth |
2,641 |
623 |
$7K |
| D1206 |
Topical application of fluoride varnish |
3,656 |
3,461 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
610 |
$4K |
| D2940 |
|
138 |
18 |
$2K |
| D1330 |
|
3,869 |
3,671 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,257 |
1,189 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
3,373 |
2,963 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
483 |
417 |
$2K |
| D0274 |
Bitewings - four radiographic images |
776 |
733 |
$730.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
142 |
$621.66 |
| D1310 |
|
41 |
40 |
$613.18 |
| D0603 |
|
186 |
177 |
$265.00 |
| D3120 |
|
415 |
147 |
$38.52 |
| D1999 |
|
58 |
48 |
$16.89 |
| D9986 |
|
110 |
62 |
$0.00 |
| D0602 |
|
44 |
44 |
$0.00 |