| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,662 |
9,564 |
$382K |
| D1351 |
Sealant - per tooth |
11,956 |
2,641 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
10,140 |
10,023 |
$351K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,984 |
10,863 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,137 |
9,155 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
2,125 |
2,107 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,518 |
1,015 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
9,683 |
9,511 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,705 |
2,674 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,141 |
5,089 |
$70K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,268 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
728 |
566 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
619 |
328 |
$51K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
84 |
84 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,151 |
2,115 |
$43K |
| D0330 |
Panoramic radiographic image |
653 |
647 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,601 |
2,362 |
$38K |
| D0603 |
|
3,241 |
3,209 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
539 |
$27K |
| D2330 |
|
333 |
218 |
$24K |
| D3333 |
|
174 |
158 |
$19K |
| D4249 |
|
84 |
79 |
$18K |
| D0601 |
|
1,357 |
1,342 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
286 |
189 |
$13K |
| D3348 |
|
12 |
12 |
$7K |
| D7111 |
|
61 |
37 |
$4K |
| D1354 |
|
1,517 |
300 |
$2K |
| D3331 |
|
12 |
12 |
$1K |
| D0602 |
|
115 |
115 |
$1K |
| D1206 |
Topical application of fluoride varnish |
48 |
48 |
$720.00 |
| D1330 |
|
4,810 |
4,690 |
$0.00 |
| D0460 |
|
937 |
670 |
$0.00 |