| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,380 |
3,289 |
$145K |
| D1206 |
Topical application of fluoride varnish |
3,262 |
3,173 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,618 |
1,575 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,666 |
1,617 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
663 |
444 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,025 |
2,889 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,209 |
2,114 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
815 |
788 |
$20K |
| D0350 |
|
1,938 |
1,188 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
657 |
614 |
$11K |
| D0330 |
Panoramic radiographic image |
287 |
283 |
$10K |
| D8660 |
|
161 |
133 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
197 |
194 |
$6K |
| D1351 |
Sealant - per tooth |
248 |
53 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
201 |
201 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
58 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
46 |
$3K |
| D0603 |
|
990 |
946 |
$2K |
| D0272 |
Bitewings - two radiographic images |
110 |
107 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
26 |
$451.00 |
| D0602 |
|
169 |
162 |
$390.00 |
| D3120 |
|
20 |
13 |
$313.50 |
| D1999 |
|
14 |
14 |
$210.00 |
| D9986 |
|
14 |
14 |
$0.00 |