| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,696 |
5,628 |
$158K |
| D1110 |
Prophylaxis - adult |
2,406 |
2,389 |
$126K |
| D1120 |
Prophylaxis - child |
3,393 |
3,360 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,857 |
5,804 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,410 |
2,393 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
726 |
436 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,628 |
2,602 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,242 |
3,191 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,976 |
2,941 |
$33K |
| D1351 |
Sealant - per tooth |
1,139 |
117 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
184 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
843 |
746 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$807.54 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$494.48 |
| D0602 |
|
2,641 |
2,616 |
$0.00 |
| D0601 |
|
3,302 |
3,280 |
$0.00 |