| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,805 |
9,727 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,316 |
2,238 |
$133K |
| D1120 |
Prophylaxis - child |
6,645 |
6,601 |
$86K |
| D1206 |
Topical application of fluoride varnish |
6,460 |
6,416 |
$75K |
| D1110 |
Prophylaxis - adult |
5,037 |
4,982 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,926 |
1,300 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,202 |
2,187 |
$41K |
| D2750 |
|
160 |
128 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,915 |
7,689 |
$38K |
| D1351 |
Sealant - per tooth |
3,630 |
586 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
9,112 |
8,873 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
929 |
706 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,259 |
3,223 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,574 |
1,544 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
503 |
372 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
725 |
721 |
$15K |
| D0272 |
Bitewings - two radiographic images |
2,971 |
2,960 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
838 |
737 |
$9K |
| D2954 |
|
69 |
56 |
$3K |
| D2335 |
|
39 |
29 |
$2K |
| D2331 |
|
39 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
45 |
$140.00 |
| D0270 |
|
69 |
45 |
$57.00 |