| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,439 |
18,678 |
$496K |
| D1120 |
Prophylaxis - child |
15,180 |
14,557 |
$398K |
| D1206 |
Topical application of fluoride varnish |
20,231 |
19,458 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,274 |
1,492 |
$230K |
| D1110 |
Prophylaxis - adult |
5,278 |
5,144 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,758 |
3,818 |
$177K |
| D0272 |
Bitewings - two radiographic images |
6,890 |
6,631 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,470 |
949 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
511 |
172 |
$70K |
| D1351 |
Sealant - per tooth |
1,815 |
499 |
$47K |
| D0330 |
Panoramic radiographic image |
797 |
760 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,418 |
1,329 |
$20K |
| D0274 |
Bitewings - four radiographic images |
562 |
544 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
278 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
97 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
198 |
$7K |
| D2330 |
|
26 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$150.96 |