| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,602 |
9,373 |
$308K |
| D1110 |
Prophylaxis - adult |
6,207 |
5,963 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,579 |
2,352 |
$266K |
| D0274 |
Bitewings - four radiographic images |
5,715 |
5,606 |
$227K |
| D1206 |
Topical application of fluoride varnish |
8,336 |
8,144 |
$210K |
| D1120 |
Prophylaxis - child |
4,451 |
4,400 |
$150K |
| D0330 |
Panoramic radiographic image |
1,897 |
1,868 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,482 |
1,639 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
2,683 |
2,595 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,290 |
746 |
$90K |
| D1351 |
Sealant - per tooth |
2,859 |
1,072 |
$78K |
| D1354 |
|
2,497 |
832 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
3,386 |
3,283 |
$55K |
| D1330 |
|
1,884 |
1,818 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
407 |
333 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
796 |
787 |
$32K |
| D2331 |
|
216 |
148 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,634 |
745 |
$19K |
| D0350 |
|
183 |
183 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
121 |
93 |
$12K |
| D2330 |
|
109 |
81 |
$5K |
| D9410 |
|
169 |
151 |
$5K |
| D0272 |
Bitewings - two radiographic images |
90 |
90 |
$3K |
| D0277 |
|
41 |
40 |
$3K |
| D9920 |
|
180 |
153 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
25 |
$600.90 |
| D4910 |
|
12 |
12 |
$89.49 |
| D9996 |
|
19 |
19 |
$0.00 |