| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,617 |
9,137 |
$160K |
| D1206 |
Topical application of fluoride varnish |
7,432 |
6,932 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
7,000 |
6,673 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,227 |
1,400 |
$77K |
| D1351 |
Sealant - per tooth |
5,620 |
1,111 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,366 |
2,224 |
$39K |
| D0601 |
|
4,611 |
4,344 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,179 |
803 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,019 |
743 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,393 |
2,391 |
$25K |
| D0602 |
|
2,038 |
1,960 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
4,185 |
3,938 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
833 |
802 |
$11K |
| D0272 |
Bitewings - two radiographic images |
2,490 |
2,368 |
$11K |
| D0603 |
|
1,560 |
1,483 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,472 |
3,118 |
$9K |
| D9920 |
|
585 |
536 |
$8K |
| D1110 |
Prophylaxis - adult |
421 |
404 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
264 |
248 |
$3K |
| D0274 |
Bitewings - four radiographic images |
279 |
275 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
18 |
$826.00 |
| D9110 |
|
31 |
30 |
$310.50 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$165.00 |
| D1999 |
|
12,864 |
11,168 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
15 |
$0.00 |
| D0191 |
|
46 |
44 |
$0.00 |
| D9986 |
|
34 |
31 |
$0.00 |
| D1330 |
|
5,674 |
5,143 |
$0.00 |
| D1310 |
|
4,905 |
4,510 |
$0.00 |
| D1355 |
|
446 |
67 |
$0.00 |