| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,250 |
5,087 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,247 |
1,124 |
$136K |
| D1110 |
Prophylaxis - adult |
1,380 |
1,356 |
$75K |
| D9920 |
|
867 |
819 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
5,885 |
5,717 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,351 |
783 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
717 |
456 |
$33K |
| D0330 |
Panoramic radiographic image |
535 |
520 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
705 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,804 |
1,667 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
324 |
$3K |
| D1351 |
Sealant - per tooth |
803 |
297 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,951 |
4,813 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,275 |
6,100 |
$1K |
| D3120 |
|
494 |
289 |
$706.14 |
| D0220 |
Intraoral - periapical first radiographic image |
5,286 |
5,140 |
$528.30 |
| D0274 |
Bitewings - four radiographic images |
1,324 |
1,298 |
$456.13 |
| D1330 |
|
5,956 |
5,795 |
$449.46 |
| D1999 |
|
40 |
37 |
$326.65 |
| D0272 |
Bitewings - two radiographic images |
3,512 |
3,422 |
$271.50 |