| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,610 |
5,554 |
$377K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,588 |
4,543 |
$207K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
630 |
507 |
$43K |
| D1351 |
Sealant - per tooth |
7,132 |
2,133 |
$37K |
| D1330 |
|
7,557 |
7,472 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
610 |
406 |
$27K |
| D0330 |
Panoramic radiographic image |
4,256 |
4,213 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
443 |
440 |
$25K |
| D0601 |
|
881 |
875 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
551 |
349 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,598 |
6,534 |
$13K |
| D1110 |
Prophylaxis - adult |
2,797 |
2,763 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
931 |
905 |
$11K |
| D0272 |
Bitewings - two radiographic images |
8,720 |
8,628 |
$11K |
| D9310 |
|
467 |
458 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
10,174 |
10,021 |
$10K |
| D1120 |
Prophylaxis - child |
4,178 |
4,145 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
185 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,271 |
8,781 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
53 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
80 |
79 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
48 |
39 |
$4K |
| D1999 |
|
68 |
66 |
$1K |
| D4355 |
|
60 |
56 |
$1K |
| D1206 |
Topical application of fluoride varnish |
220 |
212 |
$691.72 |
| D4341 |
|
37 |
12 |
$224.37 |
| D0270 |
|
13 |
12 |
$92.64 |
| D0602 |
|
13 |
13 |
$0.00 |
| D0340 |
|
13 |
13 |
$0.00 |