| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,566 |
4,309 |
$212K |
| D1120 |
Prophylaxis - child |
4,259 |
4,014 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
3,986 |
3,735 |
$114K |
| D1351 |
Sealant - per tooth |
2,512 |
660 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
937 |
611 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,187 |
779 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,002 |
1,873 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,687 |
2,488 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,642 |
2,635 |
$30K |
| D1110 |
Prophylaxis - adult |
627 |
600 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,592 |
1,461 |
$27K |
| D0274 |
Bitewings - four radiographic images |
772 |
732 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
490 |
$15K |
| D0330 |
Panoramic radiographic image |
250 |
243 |
$9K |
| D0999 |
Unspecified diagnostic procedure, by report |
156 |
156 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
147 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
141 |
140 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
41 |
$2K |
| D1354 |
|
121 |
53 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$750.36 |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
45 |
$430.08 |
| D0270 |
|
12 |
12 |
$141.48 |
| D0603 |
|
39 |
32 |
$140.00 |
| D1330 |
|
234 |
221 |
$0.00 |