| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,181 |
5,137 |
$428K |
| D1120 |
Prophylaxis - child |
5,584 |
5,513 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
868 |
525 |
$84K |
| D1110 |
Prophylaxis - adult |
1,081 |
1,069 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
413 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
520 |
289 |
$35K |
| D0330 |
Panoramic radiographic image |
529 |
523 |
$29K |
| D1206 |
Topical application of fluoride varnish |
6,654 |
6,573 |
$27K |
| D9999 |
Unspecified adjunctive procedure, by report |
382 |
373 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
282 |
$22K |
| D0240 |
|
864 |
711 |
$19K |
| D1354 |
|
5,278 |
1,057 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
57 |
42 |
$17K |
| D0272 |
Bitewings - two radiographic images |
4,472 |
4,419 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,079 |
1,022 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
248 |
$12K |
| D1351 |
Sealant - per tooth |
1,913 |
536 |
$8K |
| D9920 |
|
189 |
180 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
5,926 |
5,820 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,940 |
5,594 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,063 |
1,052 |
$3K |
| D1330 |
|
6,649 |
6,570 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
103 |
103 |
$2K |
| D0603 |
|
2,774 |
2,738 |
$259.01 |
| D0601 |
|
1,319 |
1,299 |
$103.00 |
| D0602 |
|
817 |
803 |
$76.00 |
| D9992 |
|
179 |
179 |
$0.00 |
| D9995 |
|
227 |
226 |
$0.00 |