| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,386 |
12,157 |
$550K |
| D0210 |
Intraoral - complete series of radiographic images |
1,909 |
1,867 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,053 |
1,234 |
$135K |
| D1120 |
Prophylaxis - child |
11,844 |
11,631 |
$120K |
| D1110 |
Prophylaxis - adult |
2,551 |
2,496 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,155 |
2,116 |
$91K |
| D1351 |
Sealant - per tooth |
5,540 |
1,473 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
892 |
601 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,717 |
1,633 |
$28K |
| D9920 |
|
309 |
294 |
$24K |
| D1206 |
Topical application of fluoride varnish |
13,813 |
13,554 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
575 |
399 |
$15K |
| D1354 |
|
3,209 |
778 |
$11K |
| D0272 |
Bitewings - two radiographic images |
7,957 |
7,810 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
47 |
39 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
521 |
496 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
9,056 |
8,864 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,026 |
7,868 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
131 |
131 |
$3K |
| D1330 |
|
14,527 |
14,256 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,867 |
1,825 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
44 |
$2K |
| D0601 |
|
755 |
752 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
29 |
$580.00 |
| D0603 |
|
181 |
178 |
$461.25 |
| D0602 |
|
120 |
120 |
$306.25 |
| D9996 |
|
27 |
26 |
$184.56 |