| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,797 |
3,691 |
$119K |
| D1120 |
Prophylaxis - child |
2,729 |
2,654 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,579 |
1,506 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,257 |
1,209 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,545 |
3,410 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,570 |
1,523 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
684 |
647 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
806 |
610 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,325 |
1,282 |
$29K |
| D1351 |
Sealant - per tooth |
1,278 |
310 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
340 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,923 |
1,947 |
$16K |
| D1110 |
Prophylaxis - adult |
184 |
175 |
$7K |
| D0330 |
Panoramic radiographic image |
198 |
179 |
$6K |
| D0603 |
|
1,728 |
1,678 |
$6K |
| D0270 |
|
487 |
470 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
141 |
141 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
211 |
209 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
166 |
166 |
$3K |
| D0190 |
|
239 |
231 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
76 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$738.00 |
| D0240 |
|
35 |
21 |
$594.00 |
| D1999 |
|
18 |
18 |
$270.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$143.36 |
| D0601 |
|
16 |
16 |
$65.00 |