| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,483 |
10,294 |
$743K |
| D0120 |
Periodic oral evaluation - established patient |
23,197 |
22,826 |
$703K |
| D1120 |
Prophylaxis - child |
15,261 |
14,985 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,345 |
982 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,156 |
2,125 |
$101K |
| D1351 |
Sealant - per tooth |
14,071 |
3,607 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,112 |
806 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,983 |
25,495 |
$57K |
| D0330 |
Panoramic radiographic image |
1,403 |
1,398 |
$43K |
| D0272 |
Bitewings - two radiographic images |
12,062 |
11,857 |
$28K |
| D0274 |
Bitewings - four radiographic images |
10,244 |
10,078 |
$23K |
| D1330 |
|
25,944 |
25,517 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
583 |
562 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
200 |
182 |
$14K |
| D8660 |
|
200 |
196 |
$14K |
| D9420 |
|
12 |
12 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
222 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
320 |
301 |
$12K |
| D9920 |
|
191 |
185 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
7,330 |
7,243 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,932 |
5,626 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
212 |
210 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
57 |
57 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
12 |
$688.23 |
| D0601 |
|
1,235 |
807 |
$471.00 |
| D1354 |
|
79 |
29 |
$420.28 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$324.97 |
| D0602 |
|
453 |
360 |
$234.00 |
| D3120 |
|
85 |
66 |
$176.00 |
| D0603 |
|
336 |
264 |
$112.00 |