| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,111 |
2,988 |
$146K |
| D1206 |
Topical application of fluoride varnish |
3,059 |
2,954 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,774 |
2,665 |
$68K |
| D9248 |
|
542 |
482 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,905 |
1,839 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
963 |
943 |
$30K |
| D9999 |
Unspecified adjunctive procedure, by report |
313 |
310 |
$20K |
| D1110 |
Prophylaxis - adult |
102 |
100 |
$4K |
| D0191 |
|
543 |
454 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
113 |
113 |
$3K |
| D0190 |
|
663 |
627 |
$3K |
| D1351 |
Sealant - per tooth |
121 |
37 |
$2K |
| D0160 |
|
128 |
117 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
95 |
$1K |
| D3120 |
|
92 |
54 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
59 |
$1K |
| D0601 |
|
1,264 |
1,214 |
$757.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$619.09 |
| D0602 |
|
249 |
227 |
$168.00 |
| D0603 |
|
13 |
12 |
$12.00 |
| D1999 |
|
963 |
868 |
$0.00 |
| D9986 |
|
16 |
16 |
$0.00 |