| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,953 |
16,420 |
$441K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,572 |
16,960 |
$324K |
| D1120 |
Prophylaxis - child |
12,323 |
11,886 |
$282K |
| D1110 |
Prophylaxis - adult |
5,727 |
5,534 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,317 |
1,721 |
$213K |
| D0272 |
Bitewings - two radiographic images |
13,447 |
13,015 |
$132K |
| D0330 |
Panoramic radiographic image |
2,714 |
2,608 |
$95K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,154 |
3,007 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,524 |
848 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
7,386 |
7,085 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,861 |
1,769 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
958 |
885 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
209 |
38 |
$28K |
| D1999 |
|
1,602 |
1,586 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,096 |
4,857 |
$11K |
| D1351 |
Sealant - per tooth |
438 |
115 |
$11K |
| D0274 |
Bitewings - four radiographic images |
758 |
742 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
301 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
40 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
39 |
$4K |
| D4910 |
|
16 |
16 |
$736.00 |