| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,871 |
4,183 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,005 |
1,246 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,787 |
1,545 |
$73K |
| D1110 |
Prophylaxis - adult |
1,800 |
1,627 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,342 |
880 |
$58K |
| D0330 |
Panoramic radiographic image |
1,199 |
971 |
$46K |
| D1351 |
Sealant - per tooth |
4,884 |
1,320 |
$34K |
| D0191 |
|
1,515 |
1,404 |
$28K |
| D1120 |
Prophylaxis - child |
4,624 |
4,015 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,590 |
2,338 |
$23K |
| D1206 |
Topical application of fluoride varnish |
8,587 |
7,538 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
114 |
$8K |
| D1330 |
|
8,464 |
7,450 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
58 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,534 |
1,431 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
234 |
187 |
$4K |
| D9920 |
|
115 |
106 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
2,509 |
2,143 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
25 |
$2K |
| D0190 |
|
349 |
306 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,891 |
1,663 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
164 |
$1K |
| D1354 |
|
105 |
25 |
$379.25 |
| D9996 |
|
81 |
81 |
$15.00 |
| D9986 |
|
1,475 |
1,242 |
$0.00 |
| D9987 |
|
89 |
59 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
75 |
75 |
$0.00 |
| D0240 |
|
13 |
13 |
$0.00 |