| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,590 |
5,542 |
$195K |
| D1120 |
Prophylaxis - child |
5,846 |
5,786 |
$182K |
| D1206 |
Topical application of fluoride varnish |
6,744 |
6,684 |
$180K |
| D1351 |
Sealant - per tooth |
7,174 |
1,762 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,911 |
1,580 |
$134K |
| D1110 |
Prophylaxis - adult |
1,905 |
1,898 |
$119K |
| D9999 |
Unspecified adjunctive procedure, by report |
846 |
766 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
7,910 |
7,602 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,542 |
1,523 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,411 |
7,101 |
$51K |
| D1310 |
|
3,278 |
3,246 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,300 |
2,296 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
616 |
409 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
626 |
429 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,817 |
2,767 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
704 |
699 |
$15K |
| D0999 |
Unspecified diagnostic procedure, by report |
235 |
235 |
$14K |
| D0603 |
|
1,858 |
1,818 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
156 |
106 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
113 |
70 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
155 |
153 |
$6K |
| D1354 |
|
988 |
486 |
$6K |
| D9430 |
|
189 |
187 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
62 |
$2K |
| D1999 |
|
480 |
436 |
$1K |
| D0601 |
|
252 |
235 |
$1K |
| D0602 |
|
696 |
683 |
$650.00 |
| D0350 |
|
21 |
15 |
$78.00 |
| D0270 |
|
12 |
12 |
$40.00 |
| D1330 |
|
966 |
961 |
$0.00 |
| D9993 |
|
2,319 |
2,291 |
$0.00 |
| D9987 |
|
32 |
30 |
$0.00 |