| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,718 |
8,691 |
$473K |
| D1120 |
Prophylaxis - child |
10,081 |
10,050 |
$390K |
| D1206 |
Topical application of fluoride varnish |
9,995 |
9,963 |
$142K |
| D1310 |
|
3,066 |
3,050 |
$140K |
| D1351 |
Sealant - per tooth |
5,274 |
1,840 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,479 |
7,490 |
$99K |
| D9993 |
|
1,352 |
1,350 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,828 |
1,648 |
$71K |
| D0272 |
Bitewings - two radiographic images |
4,432 |
4,418 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,197 |
2,190 |
$46K |
| D0603 |
|
2,763 |
2,748 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
718 |
400 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
540 |
539 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,403 |
2,208 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
408 |
288 |
$27K |
| D0330 |
Panoramic radiographic image |
763 |
763 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
162 |
$9K |
| D1354 |
|
256 |
226 |
$8K |
| D0350 |
|
541 |
371 |
$5K |
| D9430 |
|
80 |
76 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |
| D1999 |
|
782 |
754 |
$385.00 |
| D0601 |
|
12 |
12 |
$180.00 |