| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,598 |
10,450 |
$273K |
| D1120 |
Prophylaxis - child |
8,953 |
8,816 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,074 |
7,954 |
$131K |
| D9248 |
|
2,261 |
2,001 |
$121K |
| D1110 |
Prophylaxis - adult |
2,421 |
2,391 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
726 |
$91K |
| D9920 |
|
2,878 |
2,764 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,876 |
2,823 |
$71K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,366 |
2,320 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,181 |
484 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,626 |
2,300 |
$55K |
| D1351 |
Sealant - per tooth |
2,775 |
537 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
6,094 |
5,998 |
$49K |
| D0330 |
Panoramic radiographic image |
1,084 |
1,064 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,877 |
3,816 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
625 |
$24K |
| D9110 |
|
448 |
438 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,398 |
1,382 |
$21K |
| D1999 |
|
1,324 |
1,236 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,630 |
5,532 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
27 |
$554.12 |
| D1330 |
|
14 |
14 |
$0.00 |