| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,364 |
9,328 |
$507K |
| D1120 |
Prophylaxis - child |
9,980 |
9,931 |
$378K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,597 |
1,437 |
$168K |
| D0274 |
Bitewings - four radiographic images |
6,311 |
6,282 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,403 |
9,758 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,621 |
6,595 |
$56K |
| D1206 |
Topical application of fluoride varnish |
3,163 |
3,129 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
744 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,150 |
3,138 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
165 |
115 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
181 |
137 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
189 |
$9K |
| D2330 |
|
76 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
231 |
78 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
72 |
71 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$560.00 |
| D9430 |
|
14 |
14 |
$448.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |