| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,569 |
2,561 |
$108K |
| D1120 |
Prophylaxis - child |
2,820 |
2,802 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,623 |
3,376 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,267 |
3,243 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
624 |
617 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,132 |
1,131 |
$24K |
| D0350 |
|
1,656 |
882 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
487 |
481 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
154 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
248 |
116 |
$16K |
| D9993 |
|
248 |
248 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
327 |
323 |
$14K |
| D7111 |
|
229 |
114 |
$13K |
| D1310 |
|
248 |
248 |
$11K |
| D0272 |
Bitewings - two radiographic images |
483 |
481 |
$6K |
| D1351 |
Sealant - per tooth |
253 |
81 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
397 |
387 |
$4K |
| D4341 |
|
43 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$2K |
| D2160 |
|
26 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$770.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D0601 |
|
16 |
16 |
$240.00 |
| D0603 |
|
14 |
14 |
$195.00 |
| D1999 |
|
261 |
242 |
$40.00 |