| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9630 |
|
24,448 |
23,635 |
$1.06M |
| D1351 |
Sealant - per tooth |
21,602 |
3,129 |
$306K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,093 |
11,933 |
$229K |
| D1330 |
|
11,879 |
11,730 |
$131K |
| D0191 |
|
12,117 |
11,956 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,365 |
844 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,677 |
1,005 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,516 |
3,462 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,346 |
690 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,669 |
3,564 |
$46K |
| D1110 |
Prophylaxis - adult |
1,234 |
1,211 |
$38K |
| D4341 |
|
1,414 |
361 |
$36K |
| D9110 |
|
753 |
718 |
$36K |
| D1120 |
Prophylaxis - child |
1,576 |
1,562 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,938 |
3,790 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,408 |
1,306 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,612 |
1,582 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
338 |
$13K |
| D2394 |
|
189 |
147 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,219 |
1,208 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,958 |
2,203 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
266 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
155 |
154 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
38 |
$3K |
| D2941 |
|
49 |
19 |
$3K |
| D4346 |
|
25 |
25 |
$800.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$598.00 |
| D9996 |
|
40 |
40 |
$400.00 |
| D9920 |
|
13 |
12 |
$242.24 |
| D0190 |
|
179 |
179 |
$0.00 |