| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,384 |
7,335 |
$398K |
| D0330 |
Panoramic radiographic image |
2,244 |
2,212 |
$272K |
| D0210 |
Intraoral - complete series of radiographic images |
1,889 |
1,885 |
$204K |
| D1351 |
Sealant - per tooth |
20,488 |
4,057 |
$97K |
| D1110 |
Prophylaxis - adult |
5,138 |
5,101 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,675 |
2,661 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,871 |
9,808 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
419 |
$43K |
| D9999 |
Unspecified adjunctive procedure, by report |
966 |
925 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
840 |
514 |
$31K |
| D1120 |
Prophylaxis - child |
4,800 |
4,773 |
$29K |
| D2950 |
|
244 |
171 |
$26K |
| D1330 |
|
9,899 |
9,827 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,198 |
1,165 |
$15K |
| D0274 |
Bitewings - four radiographic images |
2,162 |
2,154 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
76 |
$5K |
| D0272 |
Bitewings - two radiographic images |
4,141 |
4,103 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
49 |
$3K |
| D0602 |
|
2,663 |
2,663 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
90 |
90 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,089 |
1,057 |
$2K |
| D0601 |
|
648 |
648 |
$648.00 |
| D0603 |
|
417 |
417 |
$417.00 |