| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,266 |
1,196 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,004 |
1,913 |
$62K |
| D9920 |
|
1,700 |
1,535 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,477 |
1,424 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
518 |
$27K |
| D1120 |
Prophylaxis - child |
597 |
597 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
551 |
$17K |
| D9420 |
|
86 |
69 |
$16K |
| D4341 |
|
228 |
53 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
175 |
105 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
88 |
72 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
124 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
950 |
$7K |
| D1351 |
Sealant - per tooth |
321 |
59 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
727 |
531 |
$4K |
| D0274 |
Bitewings - four radiographic images |
235 |
233 |
$3K |
| D0272 |
Bitewings - two radiographic images |
378 |
378 |
$3K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$2K |
| D0601 |
|
151 |
151 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
59 |
$1K |
| D1206 |
Topical application of fluoride varnish |
70 |
63 |
$663.70 |
| D9995 |
|
22 |
22 |
$390.00 |
| D0191 |
|
14 |
14 |
$210.00 |