| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,717 |
6,474 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
9,589 |
9,267 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,080 |
1,242 |
$150K |
| D1206 |
Topical application of fluoride varnish |
6,360 |
6,117 |
$129K |
| D0330 |
Panoramic radiographic image |
2,816 |
2,702 |
$123K |
| D1110 |
Prophylaxis - adult |
3,396 |
3,284 |
$114K |
| D1999 |
|
6,031 |
5,564 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,978 |
1,159 |
$110K |
| D0272 |
Bitewings - two radiographic images |
3,665 |
3,523 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,912 |
3,796 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,776 |
1,708 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
371 |
252 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
544 |
521 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
65 |
17 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
519 |
$11K |
| D9222 |
|
19 |
18 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
19 |
18 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
185 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
15 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D9612 |
|
19 |
18 |
$162.00 |