| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,353 |
7,963 |
$228K |
| D0330 |
Panoramic radiographic image |
5,095 |
4,907 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,026 |
3,030 |
$156K |
| D1110 |
Prophylaxis - adult |
3,770 |
3,662 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
7,817 |
7,480 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,037 |
5,820 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,968 |
1,450 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,224 |
9,047 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
722 |
718 |
$32K |
| D1330 |
|
12,910 |
12,347 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
2,895 |
2,764 |
$29K |
| D1206 |
Topical application of fluoride varnish |
12,917 |
12,424 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
12,957 |
12,273 |
$21K |
| D0190 |
|
1,251 |
1,209 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,026 |
884 |
$16K |
| D0274 |
Bitewings - four radiographic images |
6,907 |
6,672 |
$16K |
| D1351 |
Sealant - per tooth |
3,908 |
1,234 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
132 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
88 |
51 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
209 |
185 |
$7K |
| D0272 |
Bitewings - two radiographic images |
3,443 |
3,261 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
137 |
137 |
$3K |
| D4346 |
|
106 |
106 |
$2K |
| D4342 |
|
183 |
82 |
$1K |
| D4341 |
|
56 |
31 |
$900.84 |
| D0999 |
Unspecified diagnostic procedure, by report |
42 |
42 |
$840.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$415.21 |
| D0270 |
|
275 |
270 |
$308.23 |
| D1354 |
|
61 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
69 |
$0.00 |
| D3120 |
|
29 |
25 |
$0.00 |