| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,048 |
9,041 |
$245K |
| D1120 |
Prophylaxis - child |
9,858 |
9,850 |
$233K |
| D1206 |
Topical application of fluoride varnish |
10,282 |
10,273 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,390 |
923 |
$170K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,208 |
5,201 |
$156K |
| D1351 |
Sealant - per tooth |
4,337 |
1,037 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
1,084 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
795 |
401 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,973 |
1,919 |
$40K |
| D0330 |
Panoramic radiographic image |
865 |
865 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
166 |
56 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,951 |
2,932 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,263 |
2,261 |
$23K |
| D1999 |
|
1,619 |
1,569 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,036 |
2,326 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
786 |
767 |
$16K |
| D1110 |
Prophylaxis - adult |
264 |
264 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
94 |
$9K |
| D9920 |
|
115 |
115 |
$3K |
| D0274 |
Bitewings - four radiographic images |
155 |
155 |
$2K |
| D2332 |
|
24 |
12 |
$2K |
| D9248 |
|
13 |
13 |
$618.80 |