| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,846 |
6,472 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
6,317 |
6,060 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,989 |
1,504 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,822 |
4,559 |
$110K |
| D0274 |
Bitewings - four radiographic images |
5,283 |
5,147 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,103 |
6,779 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,806 |
5,812 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,636 |
2,587 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,349 |
1,291 |
$64K |
| D1351 |
Sealant - per tooth |
1,633 |
409 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,153 |
658 |
$52K |
| D0350 |
|
3,021 |
2,097 |
$38K |
| D1110 |
Prophylaxis - adult |
444 |
444 |
$38K |
| D9430 |
|
1,050 |
928 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
271 |
196 |
$20K |
| D1310 |
|
2,216 |
2,018 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
180 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
74 |
73 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
71 |
71 |
$4K |
| D1999 |
|
341 |
283 |
$3K |
| D7111 |
|
39 |
26 |
$2K |
| D0603 |
|
1,106 |
961 |
$2K |
| D0602 |
|
472 |
375 |
$589.00 |
| D0270 |
|
113 |
110 |
$560.00 |
| D9993 |
|
1,911 |
1,723 |
$0.00 |