| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,469 |
3,406 |
$97K |
| D1206 |
Topical application of fluoride varnish |
4,181 |
4,085 |
$89K |
| D1120 |
Prophylaxis - child |
3,372 |
3,291 |
$79K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,501 |
1,464 |
$43K |
| D1351 |
Sealant - per tooth |
892 |
236 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,473 |
2,420 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,013 |
951 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
113 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
361 |
$16K |
| D9248 |
|
257 |
238 |
$14K |
| D0330 |
Panoramic radiographic image |
155 |
151 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$1K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$625.69 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
40 |
$346.50 |