| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,008 |
8,938 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
7,548 |
7,528 |
$216K |
| D1206 |
Topical application of fluoride varnish |
9,940 |
9,864 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,402 |
2,353 |
$90K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,798 |
2,774 |
$85K |
| D1351 |
Sealant - per tooth |
3,175 |
749 |
$75K |
| D0330 |
Panoramic radiographic image |
1,520 |
1,502 |
$63K |
| D0272 |
Bitewings - two radiographic images |
5,941 |
5,899 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
302 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,426 |
4,362 |
$37K |
| D0240 |
|
2,604 |
1,289 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
366 |
117 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
990 |
949 |
$22K |
| D1110 |
Prophylaxis - adult |
478 |
478 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,518 |
3,843 |
$20K |
| D1999 |
|
1,014 |
931 |
$14K |
| D9630 |
|
240 |
238 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
39 |
$5K |
| D9248 |
|
38 |
37 |
$2K |
| D9920 |
|
13 |
13 |
$365.30 |