| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,425 |
7,690 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
7,087 |
6,460 |
$144K |
| D1351 |
Sealant - per tooth |
6,757 |
1,444 |
$123K |
| D1206 |
Topical application of fluoride varnish |
4,241 |
3,792 |
$116K |
| D9248 |
|
1,586 |
1,231 |
$98K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,065 |
363 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,117 |
2,824 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,728 |
4,378 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,400 |
772 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,098 |
593 |
$38K |
| D0330 |
Panoramic radiographic image |
1,123 |
996 |
$34K |
| D1110 |
Prophylaxis - adult |
949 |
850 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,134 |
2,598 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
257 |
$16K |
| D0274 |
Bitewings - four radiographic images |
820 |
693 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
343 |
304 |
$9K |
| D0703 |
|
737 |
712 |
$9K |
| D0350 |
|
3,534 |
3,221 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
234 |
234 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
114 |
$4K |
| D0240 |
|
187 |
112 |
$3K |
| D1353 |
|
703 |
158 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
237 |
200 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$520.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
25 |
$471.50 |
| D0601 |
|
96 |
94 |
$465.00 |
| D0603 |
|
88 |
85 |
$420.00 |
| D0602 |
|
51 |
51 |
$250.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$147.12 |
| D1999 |
|
1,185 |
1,044 |
$0.00 |