| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,461 |
8,669 |
$118K |
| D1120 |
Prophylaxis - child |
8,118 |
7,411 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,127 |
8,340 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
631 |
280 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,041 |
516 |
$23K |
| D0272 |
Bitewings - two radiographic images |
3,727 |
3,397 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
642 |
583 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
857 |
774 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
469 |
449 |
$12K |
| D1351 |
Sealant - per tooth |
1,173 |
333 |
$12K |
| D1999 |
|
834 |
808 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
924 |
799 |
$8K |
| D1110 |
Prophylaxis - adult |
223 |
221 |
$6K |
| D0330 |
Panoramic radiographic image |
206 |
201 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
915 |
841 |
$5K |
| D0601 |
|
5,218 |
4,837 |
$5K |
| D1354 |
|
686 |
194 |
$5K |
| D0602 |
|
3,671 |
3,371 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
14 |
$2K |
| D0240 |
|
194 |
85 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
65 |
$486.68 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$280.29 |
| D1330 |
|
3,653 |
3,108 |
$60.00 |
| D0191 |
|
207 |
202 |
$0.00 |
| D0603 |
|
24 |
24 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$0.00 |