| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,979 |
9,921 |
$553K |
| D1120 |
Prophylaxis - child |
12,556 |
12,485 |
$504K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,886 |
1,236 |
$123K |
| D1310 |
|
2,963 |
2,944 |
$109K |
| D9993 |
|
2,598 |
2,579 |
$100K |
| D1206 |
Topical application of fluoride varnish |
4,825 |
4,798 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,918 |
7,859 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,890 |
6,326 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,936 |
1,925 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,264 |
3,260 |
$38K |
| D1351 |
Sealant - per tooth |
1,141 |
337 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
452 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
406 |
404 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
237 |
$19K |
| D0603 |
|
1,313 |
1,307 |
$19K |
| D0350 |
|
951 |
662 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
173 |
$7K |
| D0601 |
|
273 |
273 |
$4K |
| D9430 |
|
111 |
108 |
$3K |
| D0602 |
|
88 |
86 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$1K |
| D0270 |
|
12 |
12 |
$49.50 |
| D0999 |
Unspecified diagnostic procedure, by report |
128 |
128 |
$0.00 |