| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,537 |
2,283 |
$70K |
| D1120 |
Prophylaxis - child |
2,984 |
2,675 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,348 |
2,992 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
577 |
$20K |
| D1351 |
Sealant - per tooth |
964 |
178 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
194 |
51 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
817 |
659 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
568 |
525 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,351 |
1,223 |
$12K |
| D0240 |
|
1,747 |
825 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
95 |
$10K |
| D0330 |
Panoramic radiographic image |
107 |
94 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
257 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
13 |
$2K |
| D1999 |
|
90 |
75 |
$830.00 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
16 |
$412.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
86 |
$263.07 |