| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,372 |
3,363 |
$178K |
| D1120 |
Prophylaxis - child |
4,035 |
4,017 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,278 |
4,259 |
$57K |
| D1310 |
|
1,194 |
1,180 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
637 |
326 |
$42K |
| D9993 |
|
1,038 |
1,027 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,389 |
4,297 |
$38K |
| D9430 |
|
995 |
985 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,580 |
2,503 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
524 |
483 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
328 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,696 |
1,690 |
$19K |
| D0603 |
|
1,193 |
1,176 |
$17K |
| D1351 |
Sealant - per tooth |
554 |
179 |
$15K |
| D1354 |
|
1,038 |
1,017 |
$15K |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$4K |
| D0330 |
Panoramic radiographic image |
147 |
147 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D9920 |
|
109 |
104 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
12 |
$1K |
| D0350 |
|
182 |
85 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$767.00 |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$604.80 |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$0.00 |
| D1330 |
|
30 |
30 |
$0.00 |