| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,618 |
5,533 |
$289K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,703 |
1,695 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,383 |
786 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,817 |
7,105 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,384 |
2,362 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,202 |
8,084 |
$26K |
| D0330 |
Panoramic radiographic image |
433 |
426 |
$26K |
| D1120 |
Prophylaxis - child |
6,294 |
6,207 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,077 |
1,020 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
262 |
166 |
$12K |
| D1351 |
Sealant - per tooth |
4,886 |
1,144 |
$11K |
| D1330 |
|
8,108 |
7,992 |
$10K |
| D1110 |
Prophylaxis - adult |
1,617 |
1,594 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
214 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
7,268 |
7,150 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
168 |
$7K |
| D0272 |
Bitewings - two radiographic images |
2,750 |
2,701 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
87 |
87 |
$5K |
| D9310 |
|
140 |
140 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
384 |
$3K |
| D0240 |
|
127 |
125 |
$1K |
| D0350 |
|
688 |
686 |
$1K |
| D9920 |
|
1,950 |
1,939 |
$559.79 |
| D9999 |
Unspecified adjunctive procedure, by report |
19 |
19 |
$475.00 |
| D0602 |
|
1,877 |
1,870 |
$273.48 |
| D9986 |
|
745 |
720 |
$0.00 |