| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,523 |
12,723 |
$563K |
| D1206 |
Topical application of fluoride varnish |
14,466 |
13,748 |
$481K |
| D1351 |
Sealant - per tooth |
14,155 |
3,512 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
9,209 |
8,805 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,380 |
4,943 |
$151K |
| D0272 |
Bitewings - two radiographic images |
7,707 |
7,255 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,590 |
1,647 |
$126K |
| D0274 |
Bitewings - four radiographic images |
4,778 |
4,509 |
$105K |
| D0240 |
|
4,212 |
3,790 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,584 |
512 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,354 |
1,467 |
$89K |
| D0330 |
Panoramic radiographic image |
2,313 |
2,153 |
$84K |
| D1110 |
Prophylaxis - adult |
1,563 |
1,514 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,513 |
887 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,388 |
2,976 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,550 |
4,210 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,473 |
5,673 |
$40K |
| D1353 |
|
1,983 |
775 |
$27K |
| D9999 |
Unspecified adjunctive procedure, by report |
633 |
632 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
556 |
505 |
$17K |
| D0999 |
Unspecified diagnostic procedure, by report |
506 |
505 |
$14K |
| D0603 |
|
4,588 |
3,961 |
$8K |
| D9420 |
|
250 |
196 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
566 |
431 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
29 |
$2K |
| D9248 |
|
21 |
14 |
$1K |
| D1354 |
|
85 |
29 |
$1K |
| D0602 |
|
1,281 |
1,066 |
$943.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
39 |
$676.50 |
| D0601 |
|
193 |
166 |
$145.00 |
| D9215 |
|
245 |
235 |
$43.05 |
| D1330 |
|
1,104 |
931 |
$0.00 |
| D9986 |
|
1,661 |
1,625 |
$0.00 |
| D9987 |
|
90 |
90 |
$0.00 |