| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,542 |
4,531 |
$252K |
| D1110 |
Prophylaxis - adult |
2,053 |
2,051 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,020 |
1,583 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,357 |
6,108 |
$126K |
| D1120 |
Prophylaxis - child |
2,957 |
2,950 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,632 |
1,629 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,494 |
1,091 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,179 |
3,176 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
974 |
471 |
$55K |
| D9430 |
|
1,552 |
1,524 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
928 |
925 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,999 |
1,996 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,868 |
1,863 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
255 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
638 |
$7K |
| D4910 |
|
99 |
99 |
$7K |
| D0272 |
Bitewings - two radiographic images |
397 |
397 |
$5K |
| D9993 |
|
80 |
80 |
$4K |
| D2330 |
|
52 |
39 |
$4K |
| D1310 |
|
80 |
80 |
$4K |
| D0270 |
|
536 |
530 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$925.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$520.00 |
| D1330 |
|
75 |
75 |
$0.00 |