| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,061 |
8,045 |
$437K |
| D1120 |
Prophylaxis - child |
9,867 |
9,840 |
$380K |
| D1310 |
|
2,829 |
2,823 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,624 |
9,062 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,333 |
6,309 |
$77K |
| D9993 |
|
1,215 |
1,215 |
$77K |
| D0272 |
Bitewings - two radiographic images |
6,004 |
5,983 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,727 |
1,590 |
$67K |
| D1351 |
Sealant - per tooth |
2,519 |
808 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,358 |
3,354 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,023 |
2,022 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
608 |
608 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
578 |
$32K |
| D0603 |
|
1,905 |
1,902 |
$28K |
| D9430 |
|
631 |
605 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
1,237 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
152 |
$12K |
| D0270 |
|
2,402 |
2,389 |
$12K |
| D0330 |
Panoramic radiographic image |
210 |
208 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
82 |
$6K |
| D0602 |
|
196 |
196 |
$3K |
| D0350 |
|
282 |
223 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$655.20 |
| D1999 |
|
517 |
492 |
$60.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$10.80 |