| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,973 |
9,961 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
14,697 |
14,680 |
$333K |
| D1351 |
Sealant - per tooth |
17,096 |
3,743 |
$331K |
| D1206 |
Topical application of fluoride varnish |
13,278 |
13,257 |
$278K |
| D1110 |
Prophylaxis - adult |
7,678 |
7,664 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,672 |
2,371 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,694 |
2,269 |
$175K |
| D0274 |
Bitewings - four radiographic images |
4,489 |
4,480 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,902 |
2,840 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,957 |
2,947 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,696 |
1,689 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
7,242 |
7,111 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,350 |
3,348 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,519 |
4,726 |
$36K |
| D7111 |
|
849 |
629 |
$36K |
| D0601 |
|
3,724 |
3,717 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,451 |
1,446 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
188 |
$13K |
| D0330 |
Panoramic radiographic image |
366 |
365 |
$12K |
| D2750 |
|
13 |
13 |
$5K |
| D0602 |
|
198 |
198 |
$2K |
| D0603 |
|
162 |
162 |
$1K |
| D2331 |
|
19 |
13 |
$755.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$145.00 |
| D1353 |
|
43 |
12 |
$142.00 |