| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,182 |
6,154 |
$355K |
| D1120 |
Prophylaxis - child |
7,362 |
7,325 |
$303K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,206 |
7,792 |
$163K |
| D1310 |
|
3,418 |
3,392 |
$155K |
| D1206 |
Topical application of fluoride varnish |
8,556 |
8,517 |
$141K |
| D9993 |
|
3,397 |
3,376 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,189 |
1,185 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,006 |
641 |
$67K |
| D1351 |
Sealant - per tooth |
2,304 |
671 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,918 |
2,908 |
$62K |
| D0603 |
|
3,371 |
3,346 |
$50K |
| D9430 |
|
1,362 |
1,296 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
612 |
608 |
$42K |
| D1110 |
Prophylaxis - adult |
432 |
432 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
953 |
884 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,494 |
2,482 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
284 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,123 |
1,110 |
$12K |
| D0350 |
|
1,233 |
711 |
$11K |
| D1320 |
|
537 |
537 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
29 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
83 |
$6K |
| D0340 |
|
62 |
62 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
16 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$2K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D1999 |
|
998 |
857 |
$75.00 |
| D1330 |
|
5,583 |
5,558 |
$0.00 |