| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,845 |
5,744 |
$279K |
| D1110 |
Prophylaxis - adult |
1,854 |
1,826 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,349 |
2,331 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,407 |
710 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,387 |
1,335 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,601 |
8,430 |
$44K |
| D1120 |
Prophylaxis - child |
6,363 |
6,246 |
$38K |
| D9920 |
|
457 |
454 |
$32K |
| D0274 |
Bitewings - four radiographic images |
3,002 |
2,964 |
$23K |
| D1330 |
|
8,649 |
8,478 |
$22K |
| D0330 |
Panoramic radiographic image |
447 |
443 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,564 |
8,350 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
8,862 |
8,642 |
$13K |
| D0272 |
Bitewings - two radiographic images |
3,899 |
3,828 |
$10K |
| D1351 |
Sealant - per tooth |
626 |
184 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
119 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
15 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
72 |
72 |
$2K |
| D1999 |
|
390 |
383 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
42 |
$534.38 |