| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,202 |
20,197 |
$1.14M |
| D1120 |
Prophylaxis - child |
22,781 |
22,771 |
$906K |
| D1351 |
Sealant - per tooth |
20,733 |
6,695 |
$598K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,051 |
5,214 |
$540K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98,068 |
17,067 |
$391K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,640 |
23,630 |
$307K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,475 |
2,479 |
$189K |
| D0272 |
Bitewings - two radiographic images |
15,998 |
15,992 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,807 |
2,800 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,028 |
2,078 |
$173K |
| D9430 |
|
5,209 |
4,745 |
$167K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,879 |
1,444 |
$150K |
| D1310 |
|
2,238 |
2,238 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,195 |
4,195 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,328 |
1,328 |
$85K |
| D2330 |
|
409 |
286 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
575 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,489 |
1,461 |
$18K |
| D0603 |
|
1,159 |
1,158 |
$17K |
| D1110 |
Prophylaxis - adult |
188 |
188 |
$15K |
| D0602 |
|
698 |
698 |
$10K |
| D0601 |
|
197 |
197 |
$3K |
| D2331 |
|
19 |
12 |
$2K |
| D9995 |
|
505 |
504 |
$422.40 |
| D0350 |
|
18 |
14 |
$153.60 |
| D9999 |
Unspecified adjunctive procedure, by report |
119 |
119 |
$125.04 |
| D0999 |
Unspecified diagnostic procedure, by report |
760 |
760 |
$1.00 |