| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,490 |
6,372 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,003 |
4,581 |
$115K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,079 |
1,076 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,146 |
712 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,243 |
2,200 |
$89K |
| D1120 |
Prophylaxis - child |
7,152 |
7,007 |
$83K |
| D1110 |
Prophylaxis - adult |
1,341 |
1,328 |
$44K |
| D0330 |
Panoramic radiographic image |
585 |
568 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,294 |
1,271 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,354 |
1,338 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
333 |
232 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
5,270 |
5,149 |
$19K |
| D1351 |
Sealant - per tooth |
2,282 |
604 |
$11K |
| D0601 |
|
4,053 |
3,790 |
$9K |
| D1330 |
|
8,815 |
8,646 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
113 |
$7K |
| D1206 |
Topical application of fluoride varnish |
7,527 |
7,390 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
997 |
966 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
310 |
$4K |
| D0603 |
|
790 |
773 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
105 |
105 |
$2K |
| D1999 |
|
242 |
240 |
$2K |
| D1310 |
|
121 |
108 |
$2K |
| D0602 |
|
440 |
427 |
$2K |
| D0240 |
|
14 |
13 |
$471.34 |
| D9995 |
|
18 |
18 |
$100.00 |
| D0350 |
|
1,577 |
1,557 |
$10.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
701 |
687 |
$0.00 |
| D9986 |
|
135 |
135 |
$0.00 |
| D9993 |
|
36 |
35 |
$0.00 |