| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,550 |
6,454 |
$292K |
| D1110 |
Prophylaxis - adult |
1,711 |
1,695 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,374 |
1,349 |
$74K |
| D1120 |
Prophylaxis - child |
6,253 |
6,153 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
218 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
728 |
467 |
$19K |
| D1351 |
Sealant - per tooth |
5,797 |
1,602 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,857 |
7,742 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
76 |
$10K |
| D1330 |
|
7,821 |
7,707 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
133 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,115 |
2,084 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
6,377 |
6,261 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,155 |
6,061 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
110 |
$869.13 |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$350.00 |
| D1354 |
|
55 |
12 |
$260.00 |
| D0274 |
Bitewings - four radiographic images |
1,003 |
991 |
$226.09 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$214.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$81.75 |