| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,317 |
11,309 |
$617K |
| D1120 |
Prophylaxis - child |
13,071 |
13,061 |
$498K |
| D1351 |
Sealant - per tooth |
8,024 |
2,999 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,042 |
2,307 |
$220K |
| D1206 |
Topical application of fluoride varnish |
13,081 |
13,071 |
$177K |
| D1310 |
|
3,634 |
3,630 |
$166K |
| D9993 |
|
2,287 |
2,287 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,804 |
1,209 |
$120K |
| D0272 |
Bitewings - two radiographic images |
4,179 |
4,173 |
$50K |
| D0145 |
Oral evaluation for a patient under three years of age |
796 |
796 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,953 |
3,941 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,297 |
5,317 |
$32K |
| D7111 |
|
432 |
307 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
309 |
$21K |
| D0603 |
|
1,364 |
1,364 |
$20K |
| D0274 |
Bitewings - four radiographic images |
888 |
888 |
$18K |
| D0602 |
|
1,056 |
1,054 |
$16K |
| D0601 |
|
684 |
684 |
$10K |
| D1354 |
|
111 |
111 |
$4K |
| D2330 |
|
34 |
27 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$861.00 |
| D9430 |
|
14 |
14 |
$320.00 |