| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,545 |
4,520 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,500 |
1,484 |
$188K |
| D1120 |
Prophylaxis - child |
4,724 |
4,688 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,109 |
1,162 |
$140K |
| D1110 |
Prophylaxis - adult |
1,295 |
1,289 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,366 |
5,079 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,646 |
1,637 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,222 |
3,207 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,278 |
1,267 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,756 |
4,722 |
$54K |
| D0350 |
|
5,399 |
1,956 |
$54K |
| D4910 |
|
518 |
518 |
$39K |
| D9430 |
|
879 |
837 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,229 |
1,223 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,268 |
1,228 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
146 |
$14K |
| D1351 |
Sealant - per tooth |
458 |
124 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
258 |
238 |
$10K |
| D4341 |
|
115 |
30 |
$8K |
| D0272 |
Bitewings - two radiographic images |
601 |
600 |
$7K |
| D0330 |
Panoramic radiographic image |
215 |
215 |
$6K |
| D9110 |
|
88 |
88 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D1999 |
|
98 |
98 |
$0.00 |