| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
28,310 |
23,463 |
$1.25M |
| D1120 |
Prophylaxis - child |
4,913 |
4,808 |
$249K |
| D0140 |
Limited oral evaluation - problem focused |
4,978 |
4,671 |
$195K |
| D1206 |
Topical application of fluoride varnish |
5,815 |
5,676 |
$149K |
| D9110 |
|
3,629 |
3,277 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,981 |
3,801 |
$120K |
| D1110 |
Prophylaxis - adult |
5,182 |
4,804 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
5,373 |
5,083 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,428 |
6,009 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,139 |
1,820 |
$87K |
| D1351 |
Sealant - per tooth |
1,969 |
556 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
2,564 |
2,419 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,861 |
1,410 |
$67K |
| D1354 |
|
7,175 |
1,653 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,165 |
2,031 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
453 |
298 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,207 |
1,394 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
545 |
414 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
593 |
587 |
$16K |
| D0270 |
|
2,361 |
2,167 |
$11K |
| D0272 |
Bitewings - two radiographic images |
336 |
325 |
$8K |
| D0330 |
Panoramic radiographic image |
114 |
106 |
$7K |
| D2140 |
|
205 |
151 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
109 |
$5K |
| D2954 |
|
45 |
38 |
$3K |
| D2160 |
|
52 |
39 |
$2K |
| D2331 |
|
68 |
56 |
$2K |
| D0180 |
|
134 |
127 |
$2K |
| D4342 |
|
50 |
18 |
$1K |
| D1310 |
|
6,323 |
6,047 |
$0.00 |
| D9995 |
|
757 |
706 |
$0.00 |
| D0601 |
|
292 |
288 |
$0.00 |
| D1330 |
|
8,363 |
7,944 |
$0.00 |
| D0603 |
|
3,342 |
3,214 |
$0.00 |
| D0602 |
|
459 |
447 |
$0.00 |
| 99051 |
|
59 |
56 |
$0.00 |
| D0191 |
|
91 |
86 |
$0.00 |
| D4341 |
|
26 |
13 |
$0.00 |