| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,290 |
4,204 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,619 |
774 |
$103K |
| D1110 |
Prophylaxis - adult |
1,484 |
1,454 |
$83K |
| D0330 |
Panoramic radiographic image |
780 |
764 |
$60K |
| D1120 |
Prophylaxis - child |
3,723 |
3,655 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,265 |
1,015 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
903 |
891 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
997 |
508 |
$24K |
| D0240 |
|
5,169 |
3,644 |
$19K |
| D1351 |
Sealant - per tooth |
3,348 |
803 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
391 |
192 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,246 |
5,147 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
134 |
$7K |
| D1330 |
|
5,241 |
5,142 |
$7K |
| D0272 |
Bitewings - two radiographic images |
3,082 |
3,025 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,379 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,684 |
1,399 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,578 |
1,473 |
$943.52 |
| D0140 |
Limited oral evaluation - problem focused |
149 |
143 |
$908.81 |
| D9920 |
|
45 |
24 |
$755.26 |
| D0602 |
|
15 |
15 |
$0.00 |