| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,231 |
1,155 |
$61K |
| D1110 |
Prophylaxis - adult |
463 |
438 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
813 |
812 |
$20K |
| D1120 |
Prophylaxis - child |
1,607 |
1,551 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,443 |
2,357 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
95 |
$8K |
| D8660 |
|
75 |
74 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
72 |
$5K |
| D0330 |
Panoramic radiographic image |
148 |
142 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,027 |
994 |
$3K |
| D1330 |
|
2,394 |
2,311 |
$3K |
| D1351 |
Sealant - per tooth |
1,628 |
334 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,384 |
1,294 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,221 |
1,084 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48 |
43 |
$935.42 |
| D0274 |
Bitewings - four radiographic images |
428 |
402 |
$610.48 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$300.00 |
| D3120 |
|
19 |
12 |
$144.56 |
| D0601 |
|
104 |
92 |
$39.00 |
| D9920 |
|
45 |
45 |
$35.83 |
| D9986 |
|
14 |
14 |
$0.00 |