| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,384 |
9,104 |
$410K |
| D1206 |
Topical application of fluoride varnish |
9,356 |
9,084 |
$330K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,327 |
5,168 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,134 |
2,171 |
$156K |
| D0274 |
Bitewings - four radiographic images |
6,216 |
6,038 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,289 |
8,862 |
$75K |
| D1351 |
Sealant - per tooth |
3,258 |
877 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,978 |
2,894 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
6,365 |
6,112 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,648 |
1,167 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,138 |
935 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,183 |
2,982 |
$57K |
| D0330 |
Panoramic radiographic image |
995 |
978 |
$37K |
| D9999 |
Unspecified adjunctive procedure, by report |
483 |
483 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
512 |
$16K |
| D0999 |
Unspecified diagnostic procedure, by report |
431 |
431 |
$14K |
| D7111 |
|
449 |
353 |
$14K |
| D0272 |
Bitewings - two radiographic images |
772 |
736 |
$12K |
| D1110 |
Prophylaxis - adult |
218 |
214 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
512 |
501 |
$10K |
| D0603 |
|
3,273 |
3,188 |
$5K |
| D0350 |
|
3,434 |
3,154 |
$2K |
| D0602 |
|
761 |
748 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
30 |
$1K |
| D1353 |
|
41 |
12 |
$459.20 |
| D3120 |
|
20 |
13 |
$318.24 |
| D0601 |
|
28 |
27 |
$120.00 |
| D9986 |
|
103 |
103 |
$0.00 |