| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,623 |
9,099 |
$229K |
| D1120 |
Prophylaxis - child |
7,287 |
6,935 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,672 |
933 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,697 |
8,271 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,494 |
2,319 |
$105K |
| D1110 |
Prophylaxis - adult |
2,089 |
1,990 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,702 |
2,546 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,953 |
1,836 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
615 |
574 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,616 |
610 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
220 |
171 |
$17K |
| D1351 |
Sealant - per tooth |
462 |
131 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
173 |
$7K |
| D0274 |
Bitewings - four radiographic images |
172 |
167 |
$5K |
| D1206 |
Topical application of fluoride varnish |
412 |
375 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
41 |
$5K |
| D0240 |
|
302 |
185 |
$4K |
| D0330 |
Panoramic radiographic image |
47 |
45 |
$3K |