| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
26,226 |
25,952 |
$1.14M |
| D0120 |
Periodic oral evaluation - established patient |
22,449 |
22,230 |
$985K |
| D1206 |
Topical application of fluoride varnish |
26,867 |
26,597 |
$841K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,904 |
3,168 |
$519K |
| D0272 |
Bitewings - two radiographic images |
7,396 |
7,330 |
$236K |
| D1351 |
Sealant - per tooth |
5,231 |
1,649 |
$229K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,422 |
1,668 |
$218K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,045 |
426 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,305 |
642 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,648 |
5,329 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,453 |
2,428 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,447 |
2,371 |
$105K |
| D0274 |
Bitewings - four radiographic images |
1,641 |
1,622 |
$53K |
| D9920 |
|
1,024 |
897 |
$49K |
| D1110 |
Prophylaxis - adult |
1,032 |
1,017 |
$40K |
| D0330 |
Panoramic radiographic image |
397 |
393 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,589 |
1,557 |
$21K |
| D9410 |
|
103 |
101 |
$12K |
| D9420 |
|
24 |
24 |
$8K |
| D0240 |
|
388 |
274 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$5K |
| D1354 |
|
818 |
292 |
$4K |
| D0603 |
|
334 |
331 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
91 |
89 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
83 |
$1K |
| D0601 |
|
114 |
114 |
$1K |
| D2940 |
|
24 |
12 |
$955.00 |
| D0191 |
|
502 |
500 |
$930.00 |
| D0602 |
|
85 |
85 |
$850.00 |
| D0350 |
|
24 |
24 |
$23.50 |
| D3120 |
|
161 |
83 |
$0.00 |
| D1330 |
|
44 |
44 |
$0.00 |