| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,525 |
3,447 |
$117K |
| D1110 |
Prophylaxis - adult |
1,248 |
1,219 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
901 |
876 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
528 |
336 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,403 |
1,860 |
$29K |
| D1351 |
Sealant - per tooth |
3,826 |
965 |
$20K |
| D0240 |
|
4,502 |
3,091 |
$18K |
| D0330 |
Panoramic radiographic image |
469 |
456 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,569 |
4,463 |
$18K |
| D1120 |
Prophylaxis - child |
3,562 |
3,472 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
599 |
359 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
735 |
664 |
$13K |
| D9920 |
|
204 |
194 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
63 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
128 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
293 |
287 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
26 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
755 |
699 |
$5K |
| D1330 |
|
4,312 |
4,205 |
$5K |
| D1510 |
|
15 |
12 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,249 |
1,218 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,334 |
2,209 |
$2K |
| D1354 |
|
901 |
219 |
$2K |
| D0274 |
Bitewings - four radiographic images |
689 |
672 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
34 |
34 |
$850.00 |
| D9110 |
|
49 |
43 |
$576.21 |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
175 |
$27.00 |
| D3120 |
|
41 |
28 |
$0.00 |