| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,624 |
3,597 |
$176K |
| D1110 |
Prophylaxis - adult |
1,223 |
1,218 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
719 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,705 |
4,369 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
256 |
$25K |
| D1330 |
|
4,484 |
4,450 |
$12K |
| D1120 |
Prophylaxis - child |
3,188 |
3,159 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,427 |
4,394 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,049 |
4,030 |
$8K |
| D1351 |
Sealant - per tooth |
1,273 |
322 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,295 |
1,290 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
61 |
$1K |
| D0272 |
Bitewings - two radiographic images |
882 |
872 |
$990.62 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$887.97 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
50 |
$0.00 |