| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,196 |
4,644 |
$128K |
| D1120 |
Prophylaxis - child |
4,526 |
4,348 |
$106K |
| D9920 |
|
694 |
650 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,483 |
1,426 |
$51K |
| D1110 |
Prophylaxis - adult |
782 |
751 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
658 |
420 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
664 |
388 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
354 |
240 |
$17K |
| D0330 |
Panoramic radiographic image |
247 |
243 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
302 |
$3K |
| D1351 |
Sealant - per tooth |
2,929 |
762 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,331 |
1,126 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
33 |
33 |
$725.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,849 |
3,699 |
$479.49 |
| D0220 |
Intraoral - periapical first radiographic image |
5,270 |
5,031 |
$75.00 |
| D1330 |
|
5,346 |
5,138 |
$39.54 |
| D1206 |
Topical application of fluoride varnish |
5,309 |
5,100 |
$22.99 |
| D0602 |
|
620 |
597 |
$10.00 |
| D0274 |
Bitewings - four radiographic images |
741 |
712 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,739 |
1,697 |
$0.00 |
| D0603 |
|
801 |
781 |
$0.00 |
| D0601 |
|
3,804 |
3,645 |
$0.00 |
| D1310 |
|
5,345 |
5,137 |
$0.00 |