| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,263 |
8,178 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,991 |
2,966 |
$116K |
| D0330 |
Panoramic radiographic image |
958 |
951 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
987 |
666 |
$78K |
| D1110 |
Prophylaxis - adult |
1,167 |
1,155 |
$71K |
| D1206 |
Topical application of fluoride varnish |
9,571 |
9,474 |
$62K |
| D1351 |
Sealant - per tooth |
3,403 |
777 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
6,414 |
6,343 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,934 |
2,568 |
$36K |
| D0603 |
|
2,176 |
2,169 |
$29K |
| D0601 |
|
1,189 |
1,184 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
128 |
80 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
244 |
244 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
326 |
218 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
526 |
$9K |
| D1330 |
|
9,657 |
9,558 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$5K |
| D0272 |
Bitewings - two radiographic images |
4,085 |
4,041 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,295 |
1,206 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,563 |
3,491 |
$2K |
| D0602 |
|
286 |
285 |
$2K |
| D1354 |
|
188 |
43 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,238 |
1,225 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$340.00 |
| D0270 |
|
15 |
14 |
$0.00 |