| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,789 |
7,683 |
$221K |
| D1110 |
Prophylaxis - adult |
3,763 |
3,706 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,915 |
856 |
$187K |
| D0274 |
Bitewings - four radiographic images |
4,925 |
4,851 |
$167K |
| D1120 |
Prophylaxis - child |
4,272 |
4,218 |
$155K |
| D1351 |
Sealant - per tooth |
5,285 |
1,158 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,084 |
7,975 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
8,189 |
8,070 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,055 |
7,939 |
$91K |
| D0272 |
Bitewings - two radiographic images |
3,074 |
3,033 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
476 |
433 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,479 |
1,448 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
163 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
90 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$206.58 |
| D0603 |
|
8,139 |
8,026 |
$0.00 |
| D0601 |
|
97 |
83 |
$0.00 |
| D0602 |
|
79 |
69 |
$0.00 |