| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,229 |
6,198 |
$356K |
| D1120 |
Prophylaxis - child |
5,777 |
5,753 |
$227K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,740 |
7,659 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,634 |
1,631 |
$103K |
| D1110 |
Prophylaxis - adult |
1,141 |
1,134 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,064 |
7,033 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,959 |
6,880 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,103 |
794 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,327 |
913 |
$69K |
| D0350 |
|
3,613 |
2,086 |
$34K |
| D9430 |
|
827 |
817 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,657 |
1,652 |
$20K |
| D9993 |
|
143 |
143 |
$9K |
| D1310 |
|
194 |
194 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
82 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
71 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
59 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D1352 |
|
53 |
25 |
$990.00 |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$648.00 |
| D0601 |
|
12 |
12 |
$165.00 |