| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
7,385 |
6,710 |
$329K |
| D1120 |
Prophylaxis - child |
6,867 |
6,145 |
$327K |
| D1351 |
Sealant - per tooth |
7,039 |
1,738 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,736 |
3,395 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,732 |
3,302 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,165 |
721 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,596 |
3,234 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,083 |
4,449 |
$58K |
| D1354 |
|
5,747 |
1,164 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,084 |
6,535 |
$51K |
| D1353 |
|
3,621 |
1,035 |
$50K |
| D0330 |
Panoramic radiographic image |
1,672 |
1,366 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,433 |
2,194 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,601 |
2,160 |
$38K |
| D1110 |
Prophylaxis - adult |
592 |
571 |
$25K |
| D2140 |
|
461 |
329 |
$25K |
| D4346 |
|
183 |
154 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
289 |
64 |
$21K |
| D0603 |
|
3,540 |
3,248 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,624 |
1,293 |
$11K |
| D9310 |
|
168 |
158 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
136 |
$9K |
| D0999 |
Unspecified diagnostic procedure, by report |
246 |
245 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
321 |
321 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
181 |
$5K |
| D2929 |
|
45 |
12 |
$5K |
| D9420 |
|
70 |
58 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
49 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
82 |
81 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
28 |
$1K |
| D7111 |
|
30 |
19 |
$1K |
| D1999 |
|
716 |
679 |
$945.00 |
| D9993 |
|
279 |
278 |
$92.25 |