| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
14,649 |
12,840 |
$239K |
| D1110 |
Prophylaxis - adult |
7,120 |
6,200 |
$225K |
| D1120 |
Prophylaxis - child |
8,220 |
7,248 |
$203K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,791 |
11,190 |
$159K |
| D0330 |
Panoramic radiographic image |
3,020 |
2,551 |
$116K |
| D0274 |
Bitewings - four radiographic images |
3,178 |
2,809 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,444 |
2,928 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,904 |
3,488 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
826 |
550 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,215 |
1,976 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
430 |
$34K |
| D1351 |
Sealant - per tooth |
1,485 |
472 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
338 |
209 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,276 |
1,028 |
$23K |
| D0240 |
|
1,375 |
575 |
$19K |
| D1999 |
|
1,567 |
1,291 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
889 |
771 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
82 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
87 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
73 |
$713.10 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
14 |
$0.00 |