| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,879 |
3,717 |
$69K |
| D1110 |
Prophylaxis - adult |
1,943 |
1,870 |
$69K |
| D1120 |
Prophylaxis - child |
2,393 |
2,259 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
366 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,923 |
1,839 |
$46K |
| D1351 |
Sealant - per tooth |
2,085 |
287 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
114 |
77 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,903 |
1,787 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,489 |
1,456 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,474 |
1,367 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
96 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
262 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
753 |
489 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
318 |
280 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
126 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$598.65 |
| D0603 |
|
32 |
31 |
$135.00 |