| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
17,098 |
16,510 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
8,298 |
8,178 |
$172K |
| D1110 |
Prophylaxis - adult |
2,660 |
2,617 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,206 |
3,148 |
$97K |
| D1120 |
Prophylaxis - child |
12,841 |
12,495 |
$90K |
| D1351 |
Sealant - per tooth |
6,103 |
2,224 |
$86K |
| D0330 |
Panoramic radiographic image |
1,507 |
1,482 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,160 |
1,634 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,276 |
1,061 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,143 |
10,771 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,321 |
1,317 |
$61K |
| D1206 |
Topical application of fluoride varnish |
18,284 |
17,682 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,994 |
2,947 |
$43K |
| D1354 |
|
4,401 |
1,376 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,244 |
1,189 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
289 |
203 |
$11K |
| D0272 |
Bitewings - two radiographic images |
5,921 |
5,850 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
12,445 |
12,159 |
$9K |
| D0190 |
|
1,077 |
957 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
36 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
104 |
104 |
$2K |
| D1999 |
|
28 |
28 |
$2K |
| D9920 |
|
39 |
39 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
88 |
88 |
$1K |
| D9310 |
|
41 |
41 |
$1K |
| D2940 |
|
43 |
31 |
$850.57 |
| D1310 |
|
3,982 |
3,972 |
$0.00 |
| D0603 |
|
922 |
904 |
$0.00 |