| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,257 |
9,970 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
8,079 |
7,916 |
$248K |
| D1206 |
Topical application of fluoride varnish |
10,311 |
10,014 |
$213K |
| D1351 |
Sealant - per tooth |
11,025 |
2,357 |
$199K |
| D0274 |
Bitewings - four radiographic images |
7,898 |
7,678 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,160 |
9,327 |
$85K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,052 |
960 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
10,391 |
9,487 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,049 |
1,972 |
$56K |
| D1310 |
|
4,481 |
4,296 |
$39K |
| D1999 |
|
1,489 |
1,463 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
55 |
$7K |
| D0601 |
|
3,031 |
2,937 |
$7K |
| D0602 |
|
1,276 |
1,269 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
43 |
$5K |
| D9430 |
|
257 |
216 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
66 |
66 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
66 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
159 |
155 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
132 |
$2K |
| D0272 |
Bitewings - two radiographic images |
447 |
439 |
$1K |
| D1110 |
Prophylaxis - adult |
14 |
12 |
$440.00 |
| D0603 |
|
716 |
684 |
$111.00 |
| D1330 |
|
7,314 |
6,912 |
$0.00 |
| D9993 |
|
2,017 |
1,894 |
$0.00 |
| D1354 |
|
32 |
31 |
$0.00 |