| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,724 |
6,115 |
$379K |
| D0120 |
Periodic oral evaluation - established patient |
6,321 |
5,696 |
$246K |
| D1206 |
Topical application of fluoride varnish |
6,743 |
6,134 |
$242K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,976 |
1,143 |
$222K |
| D1351 |
Sealant - per tooth |
1,357 |
875 |
$153K |
| D1110 |
Prophylaxis - adult |
1,319 |
984 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,034 |
1,654 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,340 |
1,698 |
$46K |
| D1354 |
|
908 |
500 |
$44K |
| D0330 |
Panoramic radiographic image |
1,287 |
1,022 |
$34K |
| D9110 |
|
480 |
366 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
556 |
380 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
383 |
271 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
3,078 |
2,452 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,295 |
1,847 |
$12K |
| 96127 |
|
867 |
602 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
599 |
556 |
$9K |
| D2330 |
|
109 |
46 |
$7K |
| D5110 |
|
19 |
18 |
$7K |
| D0272 |
Bitewings - two radiographic images |
440 |
366 |
$6K |
| D5120 |
|
16 |
15 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
241 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
337 |
286 |
$4K |
| D4341 |
|
14 |
12 |
$3K |
| 96160 |
|
321 |
208 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
31 |
$2K |
| 36416 |
|
611 |
546 |
$2K |
| D2331 |
|
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$869.05 |
| 90686 |
|
66 |
51 |
$636.32 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
31 |
25 |
$557.36 |
| D9996 |
|
33 |
23 |
$147.84 |
| 85018 |
|
23 |
14 |
$53.36 |
| D0602 |
|
408 |
355 |
$0.00 |
| D0603 |
|
231 |
207 |
$0.00 |
| D0601 |
|
762 |
650 |
$0.00 |