| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
9,381 |
9,280 |
$1.01M |
| D1120 |
Prophylaxis - child |
20,240 |
20,010 |
$850K |
| D1110 |
Prophylaxis - adult |
16,207 |
16,055 |
$848K |
| D0120 |
Periodic oral evaluation - established patient |
29,221 |
28,914 |
$429K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,716 |
3,390 |
$280K |
| D1351 |
Sealant - per tooth |
31,710 |
8,109 |
$273K |
| D1208 |
Topical application of fluoride, excluding varnish |
36,088 |
35,701 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,377 |
1,875 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
878 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,908 |
2,127 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,033 |
6,957 |
$90K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,467 |
1,464 |
$68K |
| D0330 |
Panoramic radiographic image |
835 |
830 |
$35K |
| D0274 |
Bitewings - four radiographic images |
13,251 |
13,121 |
$35K |
| D1330 |
|
36,317 |
35,925 |
$34K |
| D0272 |
Bitewings - two radiographic images |
12,732 |
12,596 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,428 |
1,398 |
$20K |
| D2332 |
|
282 |
176 |
$15K |
| D2335 |
|
72 |
42 |
$8K |
| D1510 |
|
29 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,579 |
1,542 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
54 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
134 |
134 |
$3K |
| D1354 |
|
491 |
118 |
$2K |
| D1999 |
|
46 |
46 |
$2K |
| D2330 |
|
34 |
28 |
$1K |
| D0601 |
|
3,234 |
3,220 |
$749.50 |
| D3120 |
|
47 |
35 |
$563.78 |
| D0603 |
|
1,840 |
1,837 |
$537.50 |
| D0602 |
|
1,328 |
1,319 |
$483.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
12 |
$0.00 |