| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13,350 |
13,160 |
$347K |
| D1120 |
Prophylaxis - child |
14,461 |
14,258 |
$335K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,717 |
15,481 |
$294K |
| D9630 |
|
4,115 |
4,040 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,303 |
1,998 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,480 |
1,712 |
$167K |
| D0220 |
Intraoral - periapical first radiographic image |
15,490 |
15,118 |
$124K |
| D0272 |
Bitewings - two radiographic images |
10,608 |
10,472 |
$106K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,492 |
3,445 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,662 |
2,613 |
$100K |
| D1351 |
Sealant - per tooth |
4,441 |
1,222 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,197 |
3,896 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,522 |
14,491 |
$87K |
| D0330 |
Panoramic radiographic image |
2,431 |
2,371 |
$81K |
| D1110 |
Prophylaxis - adult |
1,332 |
1,300 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
407 |
282 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
486 |
327 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,144 |
1,121 |
$23K |
| D1999 |
|
1,550 |
1,448 |
$21K |
| D0274 |
Bitewings - four radiographic images |
108 |
89 |
$997.95 |
| D9995 |
|
71 |
71 |
$700.00 |
| D9996 |
|
54 |
54 |
$540.00 |