| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,058 |
1,978 |
$85K |
| D1110 |
Prophylaxis - adult |
954 |
899 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
216 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
757 |
696 |
$19K |
| D1120 |
Prophylaxis - child |
1,838 |
1,752 |
$13K |
| D0330 |
Panoramic radiographic image |
281 |
271 |
$9K |
| D9920 |
|
65 |
63 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
382 |
344 |
$5K |
| D1999 |
|
2,320 |
2,213 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
34 |
$1K |
| D1351 |
Sealant - per tooth |
272 |
80 |
$736.20 |
| D0220 |
Intraoral - periapical first radiographic image |
3,009 |
2,868 |
$497.53 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$163.90 |
| D0272 |
Bitewings - two radiographic images |
1,239 |
1,195 |
$70.20 |
| D0274 |
Bitewings - four radiographic images |
1,413 |
1,334 |
$16.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,927 |
2,785 |
$0.00 |
| D1330 |
|
2,930 |
2,788 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,936 |
2,792 |
$0.00 |