| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,038 |
1,983 |
$239K |
| D1110 |
Prophylaxis - adult |
3,144 |
3,099 |
$223K |
| D9420 |
|
365 |
350 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,319 |
1,803 |
$169K |
| D1120 |
Prophylaxis - child |
3,306 |
3,221 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,277 |
747 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,239 |
2,176 |
$62K |
| D4346 |
|
450 |
441 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
3,933 |
3,885 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,111 |
797 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,364 |
583 |
$26K |
| D0274 |
Bitewings - four radiographic images |
2,579 |
2,547 |
$19K |
| D1354 |
|
1,921 |
476 |
$19K |
| D1351 |
Sealant - per tooth |
4,619 |
1,218 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
697 |
$15K |
| D1330 |
|
6,540 |
6,404 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,127 |
6,030 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,889 |
1,871 |
$9K |
| D2332 |
|
38 |
25 |
$3K |
| D2331 |
|
124 |
80 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
720 |
699 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
56 |
$418.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
35 |
$227.06 |
| D2330 |
|
36 |
25 |
$60.64 |
| D3120 |
|
20 |
15 |
$41.20 |
| D0350 |
|
365 |
351 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
357 |
344 |
$0.00 |