| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,784 |
11,554 |
$286K |
| D1120 |
Prophylaxis - child |
8,815 |
8,679 |
$200K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,664 |
11,423 |
$197K |
| D1110 |
Prophylaxis - adult |
3,456 |
3,353 |
$126K |
| D1351 |
Sealant - per tooth |
6,168 |
1,402 |
$122K |
| D0272 |
Bitewings - two radiographic images |
5,611 |
5,452 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,457 |
5,303 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
699 |
433 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
835 |
469 |
$42K |
| D0330 |
Panoramic radiographic image |
984 |
967 |
$38K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,237 |
1,225 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
155 |
$18K |
| D1999 |
|
1,059 |
1,029 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,056 |
4,674 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
574 |
540 |
$11K |
| D0274 |
Bitewings - four radiographic images |
518 |
515 |
$6K |
| D0240 |
|
667 |
348 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
103 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$2K |
| D0270 |
|
78 |
78 |
$459.36 |