| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,456 |
9,387 |
$422K |
| D1206 |
Topical application of fluoride varnish |
11,695 |
10,460 |
$374K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,431 |
1,030 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,759 |
6,069 |
$186K |
| D1351 |
Sealant - per tooth |
7,811 |
1,334 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,112 |
7,705 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,542 |
1,514 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,621 |
4,112 |
$110K |
| D9248 |
|
1,575 |
1,212 |
$96K |
| D0272 |
Bitewings - two radiographic images |
3,659 |
3,287 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
5,581 |
4,737 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,823 |
1,651 |
$52K |
| D0330 |
Panoramic radiographic image |
1,534 |
1,405 |
$49K |
| D1110 |
Prophylaxis - adult |
1,323 |
1,169 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,046 |
1,855 |
$40K |
| D9999 |
Unspecified adjunctive procedure, by report |
940 |
940 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,174 |
2,601 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,249 |
2,962 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
597 |
500 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
631 |
316 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
177 |
$16K |
| D0999 |
Unspecified diagnostic procedure, by report |
367 |
367 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
410 |
396 |
$8K |
| D3120 |
|
388 |
186 |
$7K |
| D0340 |
|
216 |
154 |
$3K |
| D1354 |
|
461 |
78 |
$3K |
| D0603 |
|
1,003 |
873 |
$2K |
| D0601 |
|
637 |
581 |
$2K |
| D1510 |
|
51 |
28 |
$2K |
| D0602 |
|
971 |
867 |
$2K |
| D9310 |
|
184 |
123 |
$922.50 |
| D2330 |
|
18 |
12 |
$845.70 |
| D1999 |
|
64 |
57 |
$825.00 |
| D0350 |
|
241 |
135 |
$574.00 |
| D0470 |
|
63 |
46 |
$461.16 |
| D2920 |
|
13 |
12 |
$273.74 |
| D0190 |
|
15 |
15 |
$215.19 |
| D8670 |
Periodic orthodontic treatment visit |
127 |
63 |
$0.00 |