| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,503 |
5,476 |
$301K |
| D1120 |
Prophylaxis - child |
6,628 |
6,596 |
$252K |
| D1351 |
Sealant - per tooth |
3,878 |
1,593 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,520 |
1,375 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
803 |
800 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
514 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,552 |
2,538 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
763 |
590 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,817 |
3,796 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,546 |
2,532 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
234 |
$21K |
| D0330 |
Panoramic radiographic image |
410 |
409 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
70 |
55 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,336 |
813 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
75 |
49 |
$5K |
| D0274 |
Bitewings - four radiographic images |
233 |
233 |
$4K |
| D1310 |
|
101 |
101 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
50 |
$3K |
| D0240 |
|
272 |
166 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
165 |
160 |
$2K |
| D2330 |
|
17 |
14 |
$1K |
| D0350 |
|
52 |
25 |
$403.20 |
| D0603 |
|
26 |
26 |
$375.00 |
| D1352 |
|
18 |
12 |
$368.50 |
| D0999 |
Unspecified diagnostic procedure, by report |
74 |
68 |
$0.00 |