| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,523 |
7,523 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
11,703 |
11,699 |
$260K |
| D1110 |
Prophylaxis - adult |
3,520 |
3,518 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,217 |
2,060 |
$134K |
| D0274 |
Bitewings - four radiographic images |
5,558 |
5,556 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,396 |
2,207 |
$106K |
| D1351 |
Sealant - per tooth |
1,694 |
1,257 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
9,399 |
9,322 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,669 |
5,666 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,409 |
1,292 |
$67K |
| D0272 |
Bitewings - two radiographic images |
5,222 |
5,221 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,081 |
2,081 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,353 |
6,347 |
$59K |
| D0330 |
Panoramic radiographic image |
1,471 |
1,471 |
$44K |
| D1354 |
|
2,978 |
1,089 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,687 |
1,687 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
3,535 |
3,500 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
2,874 |
2,864 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
193 |
180 |
$20K |
| D0270 |
|
1,486 |
1,476 |
$11K |
| D0240 |
|
577 |
574 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,796 |
1,757 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
52 |
$4K |
| D9110 |
|
204 |
204 |
$4K |
| D2331 |
|
25 |
25 |
$2K |
| D2330 |
|
32 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
31 |
$867.00 |
| D9920 |
|
16 |
16 |
$220.36 |
| D0180 |
|
26 |
26 |
$0.00 |
| D1330 |
|
5,119 |
5,119 |
$0.00 |
| D9215 |
|
1,237 |
1,218 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
1,274 |
1,222 |
$0.00 |
| D9630 |
|
993 |
992 |
$0.00 |
| D6999 |
|
41 |
36 |
$0.00 |
| D5899 |
|
71 |
56 |
$0.00 |