| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,343 |
1,339 |
$178K |
| D1120 |
Prophylaxis - child |
3,289 |
3,274 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
654 |
466 |
$76K |
| D1110 |
Prophylaxis - adult |
723 |
722 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,623 |
1,618 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
788 |
762 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
378 |
$27K |
| D1351 |
Sealant - per tooth |
2,541 |
804 |
$23K |
| D0350 |
|
5,636 |
1,335 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
332 |
303 |
$6K |
| D9920 |
|
74 |
73 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
28 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
64 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$3K |
| D7111 |
|
16 |
14 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
2,328 |
2,319 |
$2K |
| D0603 |
|
1,275 |
1,269 |
$1K |
| D2940 |
|
36 |
26 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
59 |
55 |
$1K |
| D1206 |
Topical application of fluoride varnish |
4,031 |
4,014 |
$943.00 |
| D0602 |
|
929 |
927 |
$927.00 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
38 |
$732.00 |
| D0272 |
Bitewings - two radiographic images |
2,035 |
2,027 |
$620.50 |
| D1330 |
|
4,084 |
4,066 |
$435.50 |
| D0601 |
|
327 |
327 |
$327.00 |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$39.00 |