| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,275 |
3,270 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,730 |
980 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,390 |
3,384 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,603 |
2,602 |
$65K |
| D1351 |
Sealant - per tooth |
2,228 |
520 |
$43K |
| D0191 |
|
1,504 |
1,470 |
$37K |
| D1110 |
Prophylaxis - adult |
749 |
748 |
$33K |
| D9920 |
|
1,276 |
1,181 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,241 |
1,135 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,161 |
1,157 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
491 |
320 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,004 |
1,998 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,626 |
3,557 |
$18K |
| D0601 |
|
1,951 |
1,934 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
420 |
420 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,019 |
3,009 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
114 |
$9K |
| D0330 |
Panoramic radiographic image |
186 |
186 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
159 |
$7K |
| D0602 |
|
740 |
736 |
$6K |
| D0274 |
Bitewings - four radiographic images |
420 |
419 |
$5K |
| D0603 |
|
373 |
373 |
$4K |
| D0270 |
|
406 |
405 |
$2K |
| D1353 |
|
36 |
14 |
$360.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
36 |
36 |
$0.00 |