| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,235 |
10,170 |
$270K |
| D1120 |
Prophylaxis - child |
10,735 |
10,663 |
$254K |
| D1206 |
Topical application of fluoride varnish |
10,851 |
10,772 |
$209K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,682 |
2,661 |
$80K |
| D1351 |
Sealant - per tooth |
2,948 |
624 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
278 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,375 |
3,356 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
794 |
744 |
$16K |
| D1999 |
|
1,098 |
1,066 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
213 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
64 |
$6K |
| D1354 |
|
2,006 |
507 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
128 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$980.05 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$893.55 |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
83 |
$657.36 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$188.64 |