| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,482 |
8,290 |
$243K |
| D1110 |
Prophylaxis - adult |
3,122 |
3,029 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
9,867 |
9,620 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,504 |
1,468 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,751 |
1,202 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
159 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,124 |
6,718 |
$20K |
| D1206 |
Topical application of fluoride varnish |
6,574 |
6,413 |
$18K |
| D1351 |
Sealant - per tooth |
2,269 |
699 |
$16K |
| D0272 |
Bitewings - two radiographic images |
5,804 |
5,640 |
$9K |
| D0240 |
|
3,922 |
2,893 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,342 |
5,224 |
$8K |
| D0330 |
Panoramic radiographic image |
451 |
444 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
201 |
$6K |
| D1330 |
|
12,293 |
12,003 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
128 |
113 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
768 |
704 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
99 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
7,590 |
7,310 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
71 |
$4K |
| D0274 |
Bitewings - four radiographic images |
2,717 |
2,623 |
$3K |
| D8660 |
|
376 |
314 |
$3K |
| D0340 |
|
155 |
149 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
195 |
$2K |
| D3120 |
|
1,881 |
992 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
24 |
24 |
$540.00 |
| D0350 |
|
242 |
233 |
$361.24 |
| D9986 |
|
235 |
226 |
$0.00 |