| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,268 |
8,226 |
$221K |
| D1120 |
Prophylaxis - child |
5,697 |
5,661 |
$194K |
| D0330 |
Panoramic radiographic image |
3,381 |
3,359 |
$191K |
| D1110 |
Prophylaxis - adult |
3,981 |
3,958 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,913 |
1,100 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,202 |
5,178 |
$102K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,265 |
2,065 |
$76K |
| D0272 |
Bitewings - two radiographic images |
2,708 |
2,606 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,905 |
2,807 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,360 |
1,356 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,940 |
2,648 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
126 |
45 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
385 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
152 |
$14K |
| D1351 |
Sealant - per tooth |
226 |
77 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
57 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
73 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$423.39 |