| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,859 |
1,457 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,321 |
1,779 |
$63K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,861 |
1,680 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,827 |
1,464 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
193 |
$22K |
| D1110 |
Prophylaxis - adult |
341 |
263 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,300 |
926 |
$11K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
898 |
688 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
250 |
212 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
500 |
328 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,101 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
661 |
520 |
$7K |
| 99401 |
|
246 |
144 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
274 |
$6K |
| D0274 |
Bitewings - four radiographic images |
343 |
302 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
184 |
166 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
54 |
$4K |
| D0272 |
Bitewings - two radiographic images |
327 |
264 |
$3K |
| D0330 |
Panoramic radiographic image |
170 |
163 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
66 |
59 |
$2K |
| H1000 |
Prenatal care, at-risk assessment |
130 |
126 |
$2K |
| D2140 |
|
42 |
30 |
$2K |
| 90688 |
|
74 |
59 |
$1K |
| 36416 |
|
208 |
150 |
$733.90 |
| D2331 |
|
13 |
13 |
$726.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
15 |
$586.15 |
| 90734 |
|
17 |
16 |
$477.35 |
| 90686 |
|
48 |
42 |
$370.89 |
| 85018 |
|
27 |
14 |
$62.64 |
| D1206 |
Topical application of fluoride varnish |
138 |
138 |
$0.00 |