| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,378 |
9,254 |
$422K |
| D1351 |
Sealant - per tooth |
12,499 |
2,392 |
$287K |
| D1206 |
Topical application of fluoride varnish |
5,613 |
5,545 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,012 |
5,938 |
$196K |
| D0330 |
Panoramic radiographic image |
4,332 |
4,266 |
$174K |
| D0274 |
Bitewings - four radiographic images |
6,829 |
6,726 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
3,431 |
3,360 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
7,558 |
7,451 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,228 |
4,165 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,243 |
874 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,639 |
8,881 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,487 |
2,451 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,917 |
3,868 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
376 |
261 |
$16K |
| D1353 |
|
961 |
145 |
$16K |
| D2140 |
|
282 |
212 |
$14K |
| D0999 |
Unspecified diagnostic procedure, by report |
407 |
407 |
$12K |
| D1110 |
Prophylaxis - adult |
397 |
396 |
$9K |
| D9999 |
Unspecified adjunctive procedure, by report |
431 |
431 |
$9K |
| D1999 |
|
141 |
141 |
$2K |
| D2160 |
|
13 |
12 |
$966.83 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$813.40 |