| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,087 |
2,067 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,677 |
718 |
$110K |
| D1120 |
Prophylaxis - child |
1,926 |
1,906 |
$73K |
| D1110 |
Prophylaxis - adult |
852 |
840 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,104 |
1,092 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,419 |
2,293 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,759 |
1,743 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
372 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
142 |
$14K |
| D0272 |
Bitewings - two radiographic images |
928 |
918 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
79 |
$10K |
| D9993 |
|
87 |
87 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
427 |
$5K |
| D0274 |
Bitewings - four radiographic images |
258 |
257 |
$4K |
| D1310 |
|
87 |
87 |
$4K |
| D1206 |
Topical application of fluoride varnish |
178 |
178 |
$3K |
| D9430 |
|
84 |
81 |
$3K |
| D0350 |
|
102 |
51 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
13 |
$680.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$315.00 |