| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25,096 |
23,019 |
$620K |
| D1120 |
Prophylaxis - child |
25,364 |
23,441 |
$561K |
| D1206 |
Topical application of fluoride varnish |
30,020 |
27,620 |
$540K |
| D1351 |
Sealant - per tooth |
16,174 |
4,386 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,121 |
2,985 |
$130K |
| D0272 |
Bitewings - two radiographic images |
13,333 |
11,936 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,792 |
4,439 |
$101K |
| D1110 |
Prophylaxis - adult |
2,319 |
2,183 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,175 |
847 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
3,100 |
2,861 |
$62K |
| D8670 |
Periodic orthodontic treatment visit |
157 |
156 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
450 |
349 |
$24K |
| D0330 |
Panoramic radiographic image |
511 |
478 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
261 |
173 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,880 |
1,728 |
$14K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
26 |
24 |
$12K |
| D0274 |
Bitewings - four radiographic images |
857 |
789 |
$11K |
| D1354 |
|
3,624 |
1,089 |
$11K |
| D8030 |
|
27 |
27 |
$9K |
| D0170 |
|
122 |
122 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
57 |
56 |
$4K |
| D9992 |
|
580 |
574 |
$3K |
| D2941 |
|
19 |
12 |
$572.49 |
| 90686 |
|
13 |
13 |
$202.80 |