| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,448 |
10,025 |
$309K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,546 |
12,921 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
11,839 |
11,438 |
$202K |
| D0330 |
Panoramic radiographic image |
4,597 |
4,436 |
$192K |
| D1351 |
Sealant - per tooth |
8,245 |
2,093 |
$97K |
| D1110 |
Prophylaxis - adult |
2,966 |
2,855 |
$90K |
| D0274 |
Bitewings - four radiographic images |
6,927 |
6,632 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
7,250 |
6,960 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,286 |
1,438 |
$58K |
| D1330 |
|
16,517 |
15,227 |
$58K |
| D0272 |
Bitewings - two radiographic images |
8,547 |
8,184 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,475 |
17,034 |
$36K |
| D1206 |
Topical application of fluoride varnish |
13,928 |
13,375 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
22,190 |
21,253 |
$23K |
| D4355 |
|
393 |
367 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
349 |
322 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
115 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
338 |
305 |
$8K |
| D0270 |
|
2,114 |
2,060 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
126 |
126 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
99 |
67 |
$2K |
| 99381 |
|
194 |
169 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
61 |
$1K |
| D0603 |
|
4,359 |
4,103 |
$1K |
| D0601 |
|
1,435 |
1,361 |
$271.76 |
| D0602 |
|
1,892 |
1,803 |
$62.74 |
| 3008F |
|
417 |
409 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
683 |
297 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
13 |
13 |
$0.00 |