| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,659 |
4,478 |
$120K |
| D1120 |
Prophylaxis - child |
2,493 |
2,398 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,369 |
1,466 |
$108K |
| D1110 |
Prophylaxis - adult |
2,258 |
2,139 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,553 |
1,045 |
$96K |
| D0330 |
Panoramic radiographic image |
1,128 |
1,087 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,854 |
1,788 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,963 |
1,887 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,543 |
1,470 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,538 |
2,348 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
570 |
519 |
$17K |
| D0272 |
Bitewings - two radiographic images |
901 |
852 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
502 |
488 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
273 |
103 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
215 |
204 |
$8K |
| D7111 |
|
104 |
72 |
$5K |
| D2331 |
|
55 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
211 |
123 |
$1K |
| D1351 |
Sealant - per tooth |
41 |
16 |
$692.29 |
| D9986 |
|
16 |
12 |
$0.00 |