| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,100 |
1,055 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
921 |
901 |
$31K |
| D1206 |
Topical application of fluoride varnish |
924 |
888 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
144 |
$20K |
| D2140 |
|
247 |
184 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
526 |
513 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
255 |
$7K |
| D1110 |
Prophylaxis - adult |
121 |
121 |
$6K |
| D0274 |
Bitewings - four radiographic images |
183 |
182 |
$5K |
| 96127 |
|
301 |
292 |
$4K |
| D0272 |
Bitewings - two radiographic images |
218 |
213 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
150 |
$2K |
| 85018 |
|
788 |
719 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$1K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
62 |
61 |
$887.87 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
28 |
28 |
$835.90 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
35 |
34 |
$332.10 |
| 90658 |
|
29 |
29 |
$279.28 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$226.00 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$134.40 |