| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,825 |
11,753 |
$657K |
| D1120 |
Prophylaxis - child |
11,933 |
11,841 |
$446K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,943 |
1,431 |
$182K |
| D9920 |
|
1,958 |
1,923 |
$151K |
| D1206 |
Topical application of fluoride varnish |
13,016 |
12,943 |
$147K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,300 |
$102K |
| D1351 |
Sealant - per tooth |
3,856 |
944 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,837 |
7,444 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,389 |
815 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,341 |
2,331 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
587 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,288 |
3,256 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
660 |
334 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,141 |
2,124 |
$25K |
| D9430 |
|
758 |
733 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
338 |
333 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
379 |
379 |
$15K |
| D0330 |
Panoramic radiographic image |
393 |
392 |
$11K |
| D2330 |
|
171 |
102 |
$10K |
| D2335 |
|
89 |
53 |
$8K |
| D9410 |
|
115 |
115 |
$3K |
| D9420 |
|
39 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
37 |
$288.00 |
| D0350 |
|
47 |
24 |
$153.60 |