| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,115 |
10,809 |
$259K |
| D1120 |
Prophylaxis - child |
7,748 |
7,574 |
$250K |
| D1206 |
Topical application of fluoride varnish |
10,638 |
10,368 |
$215K |
| D1110 |
Prophylaxis - adult |
5,206 |
5,042 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
1,760 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,147 |
1,481 |
$125K |
| D0330 |
Panoramic radiographic image |
2,624 |
2,537 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,550 |
3,458 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,681 |
2,322 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,680 |
2,608 |
$74K |
| D0272 |
Bitewings - two radiographic images |
4,318 |
4,232 |
$72K |
| D1351 |
Sealant - per tooth |
1,479 |
432 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,794 |
1,743 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,073 |
1,915 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
417 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
126 |
$6K |
| D2331 |
|
95 |
56 |
$6K |
| D9110 |
|
71 |
67 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
26 |
$216.42 |
| D1330 |
|
40 |
39 |
$0.00 |