| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,044 |
974 |
$44K |
| D1120 |
Prophylaxis - child |
749 |
706 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
988 |
930 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
360 |
$20K |
| D1351 |
Sealant - per tooth |
1,051 |
211 |
$19K |
| D0330 |
Panoramic radiographic image |
495 |
445 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
190 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
363 |
349 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
186 |
47 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
332 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
756 |
682 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
482 |
406 |
$8K |
| D5214 |
|
17 |
14 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
121 |
$7K |
| D0272 |
Bitewings - two radiographic images |
325 |
301 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,056 |
698 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
76 |
71 |
$3K |
| D0274 |
Bitewings - four radiographic images |
126 |
114 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
44 |
$2K |
| D4346 |
|
17 |
14 |
$2K |
| D4355 |
|
103 |
93 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$1K |
| D0191 |
|
50 |
46 |
$473.00 |
| D0603 |
|
387 |
352 |
$291.00 |
| D0602 |
|
82 |
74 |
$53.00 |
| D9986 |
|
114 |
102 |
$0.00 |