| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,414 |
12,339 |
$319K |
| D1120 |
Prophylaxis - child |
8,966 |
8,905 |
$210K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,752 |
11,680 |
$209K |
| D1110 |
Prophylaxis - adult |
2,886 |
2,878 |
$112K |
| D1351 |
Sealant - per tooth |
3,684 |
908 |
$77K |
| D0272 |
Bitewings - two radiographic images |
4,249 |
4,222 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,565 |
1,453 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
168 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,885 |
1,875 |
$23K |
| D9999 |
Unspecified adjunctive procedure, by report |
859 |
850 |
$22K |
| D1999 |
|
1,266 |
1,209 |
$15K |
| D0330 |
Panoramic radiographic image |
216 |
216 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
538 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
131 |
$3K |
| D9630 |
|
57 |
56 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
50 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
610 |
204 |
$1K |