| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,637 |
2,452 |
$108K |
| D1206 |
Topical application of fluoride varnish |
2,609 |
2,433 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,873 |
3,571 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,276 |
1,242 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,279 |
4,844 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,373 |
2,256 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,307 |
4,378 |
$48K |
| D1351 |
Sealant - per tooth |
2,251 |
300 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,801 |
$45K |
| D1110 |
Prophylaxis - adult |
1,851 |
1,745 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,178 |
1,109 |
$36K |
| D0330 |
Panoramic radiographic image |
1,103 |
950 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
231 |
83 |
$7K |
| D0160 |
|
263 |
227 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
63 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
56 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
39 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
86 |
86 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
83 |
83 |
$2K |
| D0270 |
|
67 |
54 |
$459.81 |
| D1999 |
|
14 |
14 |
$210.00 |