| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,429 |
4,205 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
4,191 |
3,954 |
$190K |
| D1206 |
Topical application of fluoride varnish |
4,455 |
4,227 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,207 |
636 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,075 |
813 |
$101K |
| D1351 |
Sealant - per tooth |
572 |
294 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,550 |
1,520 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,748 |
1,636 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
730 |
584 |
$45K |
| D1110 |
Prophylaxis - adult |
649 |
625 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
466 |
$24K |
| D0330 |
Panoramic radiographic image |
622 |
618 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
127 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
319 |
284 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
464 |
$11K |
| D0272 |
Bitewings - two radiographic images |
560 |
558 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,000 |
940 |
$9K |
| D9110 |
|
64 |
62 |
$6K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
33 |
13 |
$2K |
| D1354 |
|
46 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
92 |
$717.40 |