| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
9,781 |
9,520 |
$495K |
| D1120 |
Prophylaxis - child |
8,181 |
7,966 |
$448K |
| D0350 |
|
19,618 |
5,451 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,550 |
4,427 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
4,092 |
3,894 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
9,614 |
9,280 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,715 |
3,643 |
$117K |
| D1351 |
Sealant - per tooth |
4,245 |
885 |
$96K |
| D0330 |
Panoramic radiographic image |
2,441 |
2,381 |
$89K |
| D0274 |
Bitewings - four radiographic images |
3,715 |
3,618 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,546 |
3,454 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,636 |
8,722 |
$57K |
| D1110 |
Prophylaxis - adult |
842 |
823 |
$40K |
| D4355 |
|
515 |
493 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
631 |
610 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
475 |
169 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
95 |
$8K |
| D0240 |
|
318 |
193 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
63 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
114 |
103 |
$2K |
| D7111 |
|
16 |
12 |
$532.87 |
| D0270 |
|
52 |
50 |
$518.76 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$492.00 |