| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
20,164 |
18,600 |
$504K |
| D1206 |
Topical application of fluoride varnish |
12,731 |
12,305 |
$325K |
| D0240 |
|
7,276 |
3,628 |
$272K |
| D1354 |
|
7,032 |
1,745 |
$227K |
| D1120 |
Prophylaxis - child |
5,108 |
5,024 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
4,778 |
4,549 |
$179K |
| D0272 |
Bitewings - two radiographic images |
4,041 |
3,959 |
$140K |
| D1351 |
Sealant - per tooth |
4,461 |
1,339 |
$129K |
| D0274 |
Bitewings - four radiographic images |
2,659 |
2,596 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
2,169 |
2,156 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,926 |
1,933 |
$74K |
| D1110 |
Prophylaxis - adult |
1,104 |
1,099 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
344 |
177 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,003 |
989 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,490 |
2,424 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
619 |
421 |
$37K |
| D1330 |
|
1,274 |
1,260 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
226 |
$21K |
| D2140 |
|
394 |
299 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
119 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
228 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
279 |
278 |
$14K |
| D0191 |
|
5,703 |
5,560 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
155 |
$1K |
| D1999 |
|
10,103 |
9,580 |
$211.48 |
| D9985 |
|
91 |
85 |
$0.00 |
| D1353 |
|
29 |
15 |
$0.00 |