| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,954 |
3,598 |
$329K |
| D0120 |
Periodic oral evaluation - established patient |
12,070 |
11,920 |
$299K |
| D1110 |
Prophylaxis - adult |
6,896 |
6,789 |
$263K |
| D1206 |
Topical application of fluoride varnish |
14,284 |
14,026 |
$246K |
| D1120 |
Prophylaxis - child |
7,091 |
6,962 |
$166K |
| D0330 |
Panoramic radiographic image |
3,977 |
3,896 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,078 |
702 |
$132K |
| D0240 |
|
9,361 |
4,594 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,176 |
2,831 |
$68K |
| D0274 |
Bitewings - four radiographic images |
4,869 |
4,787 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,752 |
1,682 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,702 |
5,607 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
509 |
201 |
$33K |
| D1999 |
|
1,357 |
1,228 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
685 |
673 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,355 |
1,307 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
69 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
50 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
201 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
25 |
$2K |
| D2140 |
|
38 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
219 |
162 |
$514.29 |
| D9992 |
|
26 |
21 |
$315.00 |
| D9920 |
|
14 |
13 |
$307.72 |