| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
62,082 |
11,734 |
$1.54M |
| D1351 |
Sealant - per tooth |
38,847 |
5,944 |
$905K |
| D1120 |
Prophylaxis - child |
21,769 |
20,514 |
$827K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,843 |
2,014 |
$732K |
| D2940 |
|
13,561 |
4,894 |
$690K |
| D0120 |
Periodic oral evaluation - established patient |
17,014 |
16,182 |
$520K |
| D1206 |
Topical application of fluoride varnish |
23,967 |
22,620 |
$478K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,796 |
5,306 |
$314K |
| D0272 |
Bitewings - two radiographic images |
8,898 |
8,336 |
$233K |
| D1110 |
Prophylaxis - adult |
3,357 |
3,107 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,538 |
791 |
$144K |
| D0274 |
Bitewings - four radiographic images |
3,470 |
3,238 |
$125K |
| D0330 |
Panoramic radiographic image |
2,309 |
2,092 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
1,863 |
1,733 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,361 |
1,234 |
$56K |
| D9920 |
|
1,664 |
1,558 |
$36K |
| D1330 |
|
11,529 |
10,938 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
156 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
138 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
507 |
$6K |
| D0240 |
|
453 |
224 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
69 |
$3K |
| D9630 |
|
278 |
248 |
$3K |
| D3120 |
|
148 |
88 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
100 |
$591.64 |
| D0603 |
|
12,350 |
11,002 |
$0.00 |
| D9995 |
|
26 |
25 |
$0.00 |
| D0602 |
|
3,609 |
3,431 |
$0.00 |
| D135 |
|
1,038 |
100 |
$0.00 |
| U1351 |
|
536 |
46 |
$0.00 |
| D0601 |
|
19 |
17 |
$0.00 |
| D9986 |
|
42 |
41 |
$0.00 |
| D9996 |
|
21 |
16 |
$0.00 |