| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
29,020 |
28,785 |
$1.65M |
| D1206 |
Topical application of fluoride varnish |
31,525 |
31,238 |
$1.64M |
| D0120 |
Periodic oral evaluation - established patient |
24,090 |
23,828 |
$777K |
| D1351 |
Sealant - per tooth |
28,122 |
9,797 |
$619K |
| D0272 |
Bitewings - two radiographic images |
13,790 |
13,648 |
$290K |
| D0274 |
Bitewings - four radiographic images |
12,288 |
12,187 |
$289K |
| D0220 |
Intraoral - periapical first radiographic image |
15,127 |
14,984 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,660 |
5,598 |
$179K |
| D1353 |
|
9,217 |
4,634 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,554 |
17,853 |
$144K |
| D0330 |
Panoramic radiographic image |
3,663 |
3,635 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,448 |
7,224 |
$137K |
| D1354 |
|
10,421 |
2,679 |
$125K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,365 |
871 |
$123K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,496 |
1,494 |
$73K |
| D1355 |
|
2,703 |
670 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
645 |
476 |
$35K |
| D1110 |
Prophylaxis - adult |
670 |
665 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
568 |
396 |
$26K |
| D0603 |
|
10,681 |
10,512 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
296 |
219 |
$25K |
| D0999 |
Unspecified diagnostic procedure, by report |
606 |
606 |
$18K |
| D0240 |
|
1,048 |
608 |
$14K |
| D2140 |
|
195 |
145 |
$12K |
| D0350 |
|
227 |
213 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
165 |
165 |
$3K |
| D0602 |
|
2,791 |
2,730 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
85 |
$3K |
| D0190 |
|
188 |
176 |
$2K |
| D9993 |
|
755 |
751 |
$2K |
| D0601 |
|
1,110 |
1,092 |
$2K |
| D1999 |
|
99 |
98 |
$1K |
| D2160 |
|
22 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
16 |
$774.90 |