| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,287 |
11,230 |
$475K |
| D0120 |
Periodic oral evaluation - established patient |
10,003 |
9,983 |
$355K |
| D1206 |
Topical application of fluoride varnish |
12,749 |
12,702 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,109 |
1,859 |
$198K |
| D1310 |
|
2,287 |
2,257 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,239 |
2,054 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,183 |
1,171 |
$70K |
| D1351 |
Sealant - per tooth |
2,240 |
934 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,192 |
850 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,342 |
6,832 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,222 |
2,216 |
$50K |
| D0350 |
|
5,098 |
2,762 |
$45K |
| D1354 |
|
1,783 |
554 |
$44K |
| D1110 |
Prophylaxis - adult |
543 |
536 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,502 |
2,479 |
$34K |
| D0603 |
|
1,558 |
1,538 |
$29K |
| D4910 |
|
325 |
324 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,965 |
1,951 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
140 |
107 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
138 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
154 |
152 |
$8K |
| D1352 |
|
191 |
123 |
$6K |
| D9430 |
|
89 |
81 |
$3K |
| D9920 |
|
14 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$2K |
| D2330 |
|
21 |
14 |
$1K |
| D0602 |
|
17 |
16 |
$331.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
20 |
16 |
$11.52 |
| D1999 |
|
89 |
84 |
$0.00 |