| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,514 |
19,404 |
$1.20M |
| D1110 |
Prophylaxis - adult |
7,359 |
7,343 |
$412K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,926 |
3,564 |
$373K |
| D0330 |
Panoramic radiographic image |
2,772 |
2,767 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,735 |
2,779 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
24,058 |
23,938 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,590 |
26,458 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
990 |
987 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,234 |
3,103 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,443 |
1,436 |
$76K |
| D0272 |
Bitewings - two radiographic images |
22,292 |
22,188 |
$69K |
| D1330 |
|
26,488 |
26,357 |
$68K |
| D1351 |
Sealant - per tooth |
7,800 |
2,808 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
24,827 |
24,663 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,493 |
23,283 |
$54K |
| D9920 |
|
4,156 |
4,088 |
$35K |
| D7111 |
|
464 |
305 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
916 |
906 |
$14K |
| D1354 |
|
2,190 |
766 |
$11K |
| D1999 |
|
270 |
250 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
153 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$288.60 |
| D0274 |
Bitewings - four radiographic images |
58 |
58 |
$0.00 |