| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,527 |
3,375 |
$162K |
| D1110 |
Prophylaxis - adult |
1,034 |
983 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
793 |
749 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,662 |
4,163 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
349 |
242 |
$20K |
| D1330 |
|
4,524 |
4,303 |
$11K |
| D1120 |
Prophylaxis - child |
3,262 |
3,118 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,472 |
4,254 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,752 |
3,787 |
$6K |
| D1351 |
Sealant - per tooth |
2,948 |
852 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
284 |
232 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,020 |
968 |
$2K |
| D0272 |
Bitewings - two radiographic images |
756 |
712 |
$472.30 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$287.83 |