| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,885 |
19,636 |
$1.22M |
| D1110 |
Prophylaxis - adult |
6,630 |
6,561 |
$409K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,591 |
1,828 |
$190K |
| D0330 |
Panoramic radiographic image |
1,969 |
1,967 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,795 |
2,750 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,188 |
25,908 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
23,296 |
23,058 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,192 |
1,660 |
$107K |
| D1351 |
Sealant - per tooth |
9,845 |
2,770 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,428 |
3,280 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
926 |
911 |
$93K |
| D0272 |
Bitewings - two radiographic images |
21,183 |
20,970 |
$68K |
| D7111 |
|
1,121 |
755 |
$67K |
| D1330 |
|
26,449 |
26,170 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,932 |
23,278 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
24,847 |
24,538 |
$50K |
| D9920 |
|
6,778 |
6,623 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,334 |
1,314 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
227 |
$11K |
| D1999 |
|
102 |
96 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
59 |
59 |
$1K |
| D0274 |
Bitewings - four radiographic images |
67 |
67 |
$577.04 |
| D1354 |
|
25 |
12 |
$84.75 |
| D0270 |
|
274 |
272 |
$49.09 |
| D3120 |
|
56 |
42 |
$35.98 |