| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,043 |
4,034 |
$95K |
| D1120 |
Prophylaxis - child |
3,637 |
3,630 |
$83K |
| D1206 |
Topical application of fluoride varnish |
4,192 |
4,183 |
$69K |
| D1110 |
Prophylaxis - adult |
795 |
792 |
$28K |
| D9999 |
Unspecified adjunctive procedure, by report |
917 |
916 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,039 |
967 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
248 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,379 |
1,376 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
361 |
360 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
87 |
$7K |
| D0274 |
Bitewings - four radiographic images |
495 |
494 |
$7K |
| D1351 |
Sealant - per tooth |
356 |
121 |
$7K |
| D1999 |
|
465 |
454 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
314 |
313 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
76 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$978.65 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$916.80 |