| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,580 |
13,748 |
$259K |
| D1120 |
Prophylaxis - child |
9,676 |
9,213 |
$218K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,390 |
13,617 |
$201K |
| D0330 |
Panoramic radiographic image |
3,566 |
3,289 |
$157K |
| D1110 |
Prophylaxis - adult |
4,502 |
4,186 |
$147K |
| D1351 |
Sealant - per tooth |
5,433 |
1,581 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,931 |
1,105 |
$104K |
| D0272 |
Bitewings - two radiographic images |
5,363 |
5,071 |
$91K |
| D1354 |
|
2,759 |
1,012 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,585 |
3,115 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,068 |
1,905 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
139 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,205 |
1,138 |
$12K |
| D2140 |
|
249 |
172 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
175 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
39 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
22 |
13 |
$0.00 |