| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,019 |
4,000 |
$232K |
| D1120 |
Prophylaxis - child |
4,845 |
4,821 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,216 |
1,114 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,604 |
981 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,897 |
4,866 |
$73K |
| D1310 |
|
1,533 |
1,521 |
$70K |
| D0350 |
|
5,473 |
2,251 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
886 |
801 |
$34K |
| D9993 |
|
635 |
635 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,549 |
2,411 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,675 |
2,657 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
277 |
$18K |
| D0603 |
|
1,141 |
1,129 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,104 |
1,101 |
$13K |
| D0274 |
Bitewings - four radiographic images |
592 |
592 |
$13K |
| D2940 |
|
273 |
77 |
$12K |
| D1351 |
Sealant - per tooth |
282 |
114 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$1K |
| D1354 |
|
12 |
12 |
$340.00 |
| D0602 |
|
13 |
13 |
$195.00 |
| D1999 |
|
151 |
146 |
$92.00 |