| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,147 |
2,132 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,468 |
2,449 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
540 |
539 |
$31K |
| D1330 |
|
2,704 |
2,681 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
519 |
324 |
$20K |
| D1351 |
Sealant - per tooth |
1,391 |
423 |
$16K |
| D0330 |
Panoramic radiographic image |
1,434 |
1,424 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,583 |
2,512 |
$13K |
| D0272 |
Bitewings - two radiographic images |
3,644 |
3,612 |
$13K |
| D1120 |
Prophylaxis - child |
1,882 |
1,866 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
130 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,799 |
2,745 |
$4K |
| D1206 |
Topical application of fluoride varnish |
541 |
536 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,079 |
2,060 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
48 |
$3K |
| D1110 |
Prophylaxis - adult |
352 |
351 |
$1K |
| D8660 |
|
13 |
13 |
$1K |
| D9310 |
|
60 |
60 |
$1K |