| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,580 |
9,542 |
$539K |
| D1120 |
Prophylaxis - child |
11,280 |
11,238 |
$426K |
| D1206 |
Topical application of fluoride varnish |
9,152 |
9,113 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,140 |
11,122 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,551 |
793 |
$102K |
| D0272 |
Bitewings - two radiographic images |
8,728 |
8,694 |
$96K |
| D1310 |
|
2,115 |
2,107 |
$96K |
| D1351 |
Sealant - per tooth |
3,302 |
979 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,094 |
2,059 |
$81K |
| D9993 |
|
932 |
932 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
629 |
400 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,490 |
2,466 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
262 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,752 |
1,751 |
$20K |
| D0603 |
|
1,004 |
1,002 |
$15K |
| D0350 |
|
1,244 |
829 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
88 |
52 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
160 |
$9K |
| D1320 |
|
342 |
339 |
$3K |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$2K |
| D0601 |
|
135 |
135 |
$2K |
| D0274 |
Bitewings - four radiographic images |
77 |
77 |
$2K |
| D0340 |
|
27 |
27 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D1330 |
|
14 |
14 |
$0.00 |