| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
3,982 |
3,130 |
$185K |
| D1110 |
Prophylaxis - adult |
3,213 |
3,099 |
$170K |
| D1120 |
Prophylaxis - child |
6,141 |
5,896 |
$145K |
| D0330 |
Panoramic radiographic image |
1,241 |
1,180 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,080 |
1,029 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,245 |
726 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
8,272 |
7,967 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,069 |
8,716 |
$21K |
| D1351 |
Sealant - per tooth |
5,261 |
1,313 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
74 |
$11K |
| D0274 |
Bitewings - four radiographic images |
3,663 |
3,550 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
219 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
147 |
$7K |
| D1330 |
|
9,238 |
8,930 |
$5K |
| D0272 |
Bitewings - two radiographic images |
3,458 |
3,305 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,191 |
4,043 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
209 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,911 |
3,774 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
274 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
16 |
16 |
$400.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |