| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,754 |
5,731 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
7,721 |
7,688 |
$183K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,525 |
944 |
$142K |
| D1351 |
Sealant - per tooth |
3,475 |
1,207 |
$116K |
| D1110 |
Prophylaxis - adult |
2,536 |
2,523 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,384 |
8,338 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,563 |
3,543 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,440 |
492 |
$62K |
| D0272 |
Bitewings - two radiographic images |
4,610 |
4,599 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,262 |
5,083 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
776 |
569 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
524 |
277 |
$28K |
| D0330 |
Panoramic radiographic image |
772 |
770 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,705 |
4,564 |
$23K |
| D9243 |
|
315 |
306 |
$12K |
| D2330 |
|
185 |
129 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
326 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
458 |
$6K |
| D9239 |
|
112 |
109 |
$3K |
| D1206 |
Topical application of fluoride varnish |
111 |
110 |
$2K |
| D9430 |
|
130 |
127 |
$2K |
| D0350 |
|
390 |
388 |
$1K |
| D9110 |
|
59 |
58 |
$1K |
| D1999 |
|
23 |
23 |
$1K |
| D9920 |
|
64 |
60 |
$1K |
| D0601 |
|
81 |
81 |
$81.00 |
| D0602 |
|
19 |
19 |
$19.00 |
| D1330 |
|
108 |
107 |
$0.00 |
| D9248 |
|
15 |
14 |
$0.00 |