| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,752 |
6,673 |
$408K |
| D1110 |
Prophylaxis - adult |
2,098 |
2,074 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,000 |
1,461 |
$150K |
| D1330 |
|
8,938 |
8,825 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,245 |
959 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,024 |
674 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
7,702 |
7,606 |
$20K |
| D0330 |
Panoramic radiographic image |
784 |
775 |
$15K |
| D1351 |
Sealant - per tooth |
2,957 |
885 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
53 |
$13K |
| D1206 |
Topical application of fluoride varnish |
8,546 |
8,435 |
$12K |
| D1999 |
|
151 |
148 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,907 |
1,740 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
376 |
372 |
$4K |
| D0272 |
Bitewings - two radiographic images |
5,199 |
5,141 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,148 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,907 |
7,497 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
8,037 |
7,905 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
81 |
81 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,010 |
1,988 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| D3120 |
|
18 |
14 |
$16.42 |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
80 |
$0.00 |