| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,190 |
3,158 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
841 |
420 |
$65K |
| D9920 |
|
647 |
645 |
$55K |
| D1110 |
Prophylaxis - adult |
649 |
641 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
255 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,704 |
3,665 |
$16K |
| D0330 |
Panoramic radiographic image |
158 |
152 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
3,406 |
3,369 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
390 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
111 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
852 |
821 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,902 |
1,876 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,893 |
2,844 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,685 |
2,631 |
$3K |
| D1330 |
|
3,850 |
3,810 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
79 |
$994.87 |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$985.00 |
| D0274 |
Bitewings - four radiographic images |
508 |
501 |
$842.35 |
| D3120 |
|
236 |
107 |
$529.75 |
| D1351 |
Sealant - per tooth |
176 |
73 |
$345.48 |