| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,374 |
7,261 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,791 |
2,046 |
$169K |
| D1110 |
Prophylaxis - adult |
3,383 |
3,332 |
$146K |
| D0330 |
Panoramic radiographic image |
1,740 |
1,702 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,753 |
2,700 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,410 |
1,408 |
$74K |
| D1206 |
Topical application of fluoride varnish |
10,341 |
10,182 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,579 |
1,134 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,401 |
10,646 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
8,155 |
8,042 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,640 |
2,409 |
$30K |
| D1351 |
Sealant - per tooth |
1,745 |
578 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
346 |
345 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
262 |
$15K |
| D1330 |
|
11,068 |
10,899 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
987 |
959 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
11,488 |
11,197 |
$10K |
| D0274 |
Bitewings - four radiographic images |
3,499 |
3,447 |
$8K |
| D7111 |
|
299 |
200 |
$7K |
| D0272 |
Bitewings - two radiographic images |
4,166 |
4,095 |
$6K |
| D0240 |
|
294 |
259 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
60 |
$3K |
| D0603 |
|
2,108 |
1,666 |
$913.00 |
| D0602 |
|
842 |
729 |
$453.00 |
| D0601 |
|
1,069 |
897 |
$354.00 |
| D0350 |
|
138 |
111 |
$264.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
322 |
$114.94 |
| D3120 |
|
77 |
53 |
$32.42 |