| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,646 |
1,330 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,889 |
1,549 |
$48K |
| D1351 |
Sealant - per tooth |
1,893 |
245 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,410 |
1,207 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,456 |
1,474 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
378 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
787 |
$16K |
| D0330 |
Panoramic radiographic image |
574 |
496 |
$16K |
| D0274 |
Bitewings - four radiographic images |
777 |
656 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,775 |
1,450 |
$14K |
| D1110 |
Prophylaxis - adult |
533 |
470 |
$14K |
| D0240 |
|
505 |
467 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
159 |
26 |
$6K |
| D0272 |
Bitewings - two radiographic images |
485 |
389 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
154 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
28 |
15 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
88 |
$1K |
| D2140 |
|
63 |
14 |
$1K |
| D9222 |
|
26 |
15 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$863.25 |
| D1353 |
|
36 |
12 |
$442.80 |
| D0601 |
|
179 |
155 |
$142.00 |
| D0603 |
|
113 |
90 |
$54.00 |
| D0602 |
|
57 |
41 |
$27.00 |
| D9993 |
|
263 |
205 |
$15.00 |
| D9986 |
|
171 |
162 |
$0.00 |
| D9987 |
|
51 |
48 |
$0.00 |
| D1310 |
|
67 |
42 |
$0.00 |