| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
423 |
356 |
$94.00 |
| D1120 |
Prophylaxis - child |
1,879 |
1,812 |
$94.00 |
| D1110 |
Prophylaxis - adult |
327 |
312 |
$84.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
666 |
$80.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,230 |
2,144 |
$71.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,506 |
1,473 |
$44.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,924 |
646 |
$24.00 |
| D0274 |
Bitewings - four radiographic images |
599 |
565 |
$22.00 |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
889 |
$10.00 |
| D0140 |
Limited oral evaluation - problem focused |
294 |
283 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
839 |
800 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
409 |
218 |
$0.00 |
| D1351 |
Sealant - per tooth |
253 |
74 |
$0.00 |
| D3110 |
|
18 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
273 |
270 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
246 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
88 |
$0.00 |