| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,297 |
3,288 |
$106K |
| D1120 |
Prophylaxis - child |
4,147 |
4,128 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,476 |
4,432 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,108 |
563 |
$82K |
| D1351 |
Sealant - per tooth |
2,831 |
601 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,004 |
427 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,277 |
$50K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,187 |
1,177 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,416 |
1,318 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,677 |
2,652 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
124 |
26 |
$21K |
| D0330 |
Panoramic radiographic image |
512 |
509 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,246 |
1,221 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
359 |
$9K |
| D1110 |
Prophylaxis - adult |
166 |
165 |
$8K |
| D0274 |
Bitewings - four radiographic images |
463 |
462 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
49 |
$4K |
| D0240 |
|
477 |
246 |
$4K |
| D9248 |
|
57 |
53 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,446 |
607 |
$3K |
| D9630 |
|
46 |
46 |
$2K |
| D1999 |
|
111 |
98 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$1K |