| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32,184 |
31,748 |
$853K |
| D1120 |
Prophylaxis - child |
29,362 |
28,967 |
$698K |
| D1206 |
Topical application of fluoride varnish |
32,481 |
32,040 |
$630K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,497 |
7,406 |
$220K |
| D1110 |
Prophylaxis - adult |
5,177 |
5,109 |
$206K |
| D0220 |
Intraoral - periapical first radiographic image |
18,048 |
17,653 |
$145K |
| D0272 |
Bitewings - two radiographic images |
9,702 |
9,537 |
$98K |
| D0330 |
Panoramic radiographic image |
2,396 |
2,377 |
$95K |
| D1351 |
Sealant - per tooth |
3,943 |
969 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,719 |
1,708 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,980 |
2,813 |
$65K |
| D9630 |
|
1,391 |
1,276 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,681 |
2,576 |
$55K |
| D0274 |
Bitewings - four radiographic images |
3,397 |
3,345 |
$50K |
| D1999 |
|
3,855 |
3,744 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,043 |
15,464 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
437 |
196 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
287 |
186 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
148 |
27 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
81 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
226 |
225 |
$5K |
| D1354 |
|
301 |
61 |
$891.00 |