| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,269 |
1,249 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
513 |
233 |
$34K |
| D1351 |
Sealant - per tooth |
1,154 |
297 |
$23K |
| D1120 |
Prophylaxis - child |
976 |
960 |
$22K |
| D1110 |
Prophylaxis - adult |
527 |
521 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
1,023 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,180 |
1,159 |
$15K |
| D0330 |
Panoramic radiographic image |
305 |
303 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
231 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
66 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
56 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
109 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
97 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
119 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
263 |
$2K |
| D1206 |
Topical application of fluoride varnish |
134 |
133 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$128.00 |