| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,958 |
5,786 |
$260K |
| D1206 |
Topical application of fluoride varnish |
5,830 |
5,667 |
$208K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
64 |
62 |
$182K |
| D1351 |
Sealant - per tooth |
5,412 |
925 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,838 |
2,752 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,603 |
3,480 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,924 |
1,882 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
4,310 |
4,151 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,380 |
5,424 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
805 |
504 |
$40K |
| D8660 |
|
420 |
413 |
$20K |
| D0330 |
Panoramic radiographic image |
519 |
511 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
161 |
26 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
507 |
481 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
126 |
$7K |
| D0350 |
|
2,189 |
1,805 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
107 |
107 |
$3K |
| D1110 |
Prophylaxis - adult |
64 |
64 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
91 |
91 |
$2K |
| D0603 |
|
511 |
492 |
$2K |
| D0272 |
Bitewings - two radiographic images |
88 |
87 |
$1K |
| D9420 |
|
29 |
29 |
$1K |
| D0602 |
|
295 |
284 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$953.25 |
| D0601 |
|
233 |
231 |
$409.25 |