| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,188 |
7,547 |
$474K |
| D1206 |
Topical application of fluoride varnish |
10,969 |
10,172 |
$398K |
| D0120 |
Periodic oral evaluation - established patient |
8,883 |
8,043 |
$350K |
| D1351 |
Sealant - per tooth |
2,941 |
1,761 |
$288K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,048 |
2,821 |
$93K |
| D1354 |
|
2,067 |
989 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,315 |
1,004 |
$86K |
| D0272 |
Bitewings - two radiographic images |
4,198 |
3,892 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,725 |
1,608 |
$44K |
| 99201 |
|
1,509 |
1,158 |
$40K |
| D2140 |
|
1,046 |
815 |
$40K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,325 |
2,657 |
$39K |
| 96160 |
|
1,559 |
1,143 |
$22K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
611 |
508 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
308 |
247 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,251 |
1,991 |
$18K |
| 83655 |
|
1,416 |
904 |
$17K |
| 36416 |
|
2,446 |
2,043 |
$9K |
| 90734 |
|
388 |
345 |
$6K |
| 90716 |
|
54 |
41 |
$3K |
| 90715 |
|
196 |
168 |
$3K |
| 85018 |
|
1,227 |
871 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| 86701 |
|
150 |
91 |
$2K |
| 86580 |
|
343 |
215 |
$1K |
| 90686 |
|
128 |
89 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
175 |
$1K |
| 90713 |
|
28 |
26 |
$536.40 |
| 90710 |
|
36 |
35 |
$364.43 |
| 90651 |
|
15 |
14 |
$308.60 |
| 90744 |
|
15 |
15 |
$269.62 |
| 90670 |
|
25 |
25 |
$160.00 |
| 90696 |
|
20 |
19 |
$128.00 |
| D0601 |
|
715 |
435 |
$0.00 |
| D0603 |
|
194 |
102 |
$0.00 |
| D0602 |
|
83 |
45 |
$0.00 |