| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,859 |
4,762 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,345 |
834 |
$127K |
| D1351 |
Sealant - per tooth |
4,685 |
1,147 |
$122K |
| D1110 |
Prophylaxis - adult |
2,119 |
2,090 |
$112K |
| D1120 |
Prophylaxis - child |
3,209 |
3,143 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,346 |
869 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
696 |
683 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,425 |
5,316 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
917 |
903 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,082 |
1,900 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,540 |
1,520 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,157 |
2,113 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,947 |
3,848 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
325 |
179 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,674 |
3,473 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
395 |
$13K |
| D0330 |
Panoramic radiographic image |
72 |
71 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$832.78 |
| D9986 |
|
61 |
59 |
$0.00 |
| D0603 |
|
3,943 |
3,873 |
$0.00 |
| D0602 |
|
1,985 |
1,944 |
$0.00 |
| D0601 |
|
535 |
526 |
$0.00 |