| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,292 |
4,671 |
$199K |
| D0330 |
Panoramic radiographic image |
6,506 |
5,523 |
$187K |
| D1351 |
Sealant - per tooth |
8,407 |
1,352 |
$165K |
| D1206 |
Topical application of fluoride varnish |
5,099 |
4,508 |
$153K |
| D0274 |
Bitewings - four radiographic images |
6,787 |
5,922 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,317 |
3,647 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
10,623 |
9,193 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,953 |
8,533 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
2,876 |
2,422 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,670 |
2,526 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,017 |
1,845 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
506 |
253 |
$24K |
| D1110 |
Prophylaxis - adult |
615 |
571 |
$17K |
| D0999 |
Unspecified diagnostic procedure, by report |
472 |
472 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
402 |
189 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
556 |
554 |
$10K |
| D1999 |
|
1,106 |
831 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
24 |
$2K |
| D8660 |
|
40 |
38 |
$2K |
| D0340 |
|
75 |
65 |
$1K |
| D1353 |
|
75 |
12 |
$1K |
| D0350 |
|
33 |
32 |
$553.50 |
| D1330 |
|
1,498 |
1,150 |
$0.00 |