| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18,386 |
18,337 |
$1.04M |
| D1120 |
Prophylaxis - child |
22,437 |
22,377 |
$880K |
| D1351 |
Sealant - per tooth |
20,514 |
5,336 |
$579K |
| D1310 |
|
7,044 |
7,031 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,670 |
2,848 |
$306K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,729 |
2,266 |
$251K |
| D2330 |
|
3,305 |
1,692 |
$248K |
| D9993 |
|
3,824 |
3,824 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,229 |
17,180 |
$231K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,508 |
2,230 |
$198K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,768 |
2,764 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,692 |
16,044 |
$173K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,963 |
1,955 |
$121K |
| D0272 |
Bitewings - two radiographic images |
10,238 |
10,214 |
$120K |
| D1206 |
Topical application of fluoride varnish |
4,777 |
4,767 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,494 |
3,480 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,605 |
5,496 |
$66K |
| D0603 |
|
3,609 |
3,602 |
$52K |
| D0330 |
Panoramic radiographic image |
1,781 |
1,773 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
995 |
995 |
$46K |
| D9430 |
|
1,249 |
1,222 |
$39K |
| D0601 |
|
2,725 |
2,719 |
$39K |
| D9920 |
|
192 |
192 |
$18K |
| D1510 |
|
113 |
106 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
120 |
$12K |
| D0350 |
|
1,232 |
723 |
$10K |
| D0602 |
|
626 |
626 |
$9K |
| D1354 |
|
482 |
319 |
$8K |
| D2331 |
|
41 |
27 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
29 |
$1K |