| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,341 |
3,299 |
$92K |
| D1206 |
Topical application of fluoride varnish |
4,349 |
4,289 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,156 |
291 |
$56K |
| D9310 |
|
767 |
761 |
$55K |
| D9999 |
Unspecified adjunctive procedure, by report |
478 |
467 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
3,034 |
2,995 |
$50K |
| D9920 |
|
776 |
749 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,900 |
1,879 |
$31K |
| D1110 |
Prophylaxis - adult |
667 |
656 |
$26K |
| D3120 |
|
1,395 |
255 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
838 |
$22K |
| D4211 |
|
97 |
27 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,200 |
677 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
179 |
57 |
$18K |
| D0274 |
Bitewings - four radiographic images |
496 |
493 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
470 |
124 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
991 |
$9K |
| D9994 |
|
814 |
790 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
2,080 |
453 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
104 |
$2K |
| D2330 |
|
32 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
38 |
$2K |
| D0330 |
Panoramic radiographic image |
86 |
86 |
$2K |
| D9992 |
|
81 |
81 |
$670.68 |
| D9440 |
|
14 |
14 |
$451.92 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$372.45 |
| D0270 |
|
62 |
54 |
$247.01 |