| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
975 |
945 |
$70K |
| D1120 |
Prophylaxis - child |
1,306 |
1,231 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,263 |
1,188 |
$37K |
| D0999 |
Unspecified diagnostic procedure, by report |
129 |
89 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
81 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
86 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
60 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
62 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
194 |
$521.88 |
| D0272 |
Bitewings - two radiographic images |
325 |
319 |
$491.88 |
| D0330 |
Panoramic radiographic image |
144 |
140 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
94 |
92 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
142 |
$0.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
129 |
$0.00 |
| D1354 |
|
48 |
40 |
$0.00 |
| D0603 |
|
265 |
264 |
$0.00 |
| D0601 |
|
112 |
112 |
$0.00 |
| D1351 |
Sealant - per tooth |
56 |
47 |
$0.00 |
| D0602 |
|
93 |
93 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |