| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,421 |
2,409 |
$180K |
| D9999 |
Unspecified adjunctive procedure, by report |
973 |
955 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
597 |
591 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,628 |
1,852 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
111 |
$13K |
| D1351 |
Sealant - per tooth |
405 |
104 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
39 |
$3K |
| D1120 |
Prophylaxis - child |
2,339 |
2,325 |
$3K |
| D1330 |
|
3,085 |
3,068 |
$2K |
| D1206 |
Topical application of fluoride varnish |
2,228 |
2,213 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
204 |
200 |
$531.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,056 |
2,039 |
$489.38 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$384.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$382.00 |
| D1110 |
Prophylaxis - adult |
630 |
628 |
$55.00 |
| D0272 |
Bitewings - two radiographic images |
424 |
420 |
$52.00 |
| D0601 |
|
2,090 |
2,062 |
$49.00 |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$44.00 |
| D0350 |
|
676 |
675 |
$21.00 |
| D0603 |
|
171 |
168 |
$10.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
604 |
603 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
569 |
566 |
$0.00 |