| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,456 |
8,184 |
$352K |
| D1206 |
Topical application of fluoride varnish |
9,310 |
8,979 |
$314K |
| D1351 |
Sealant - per tooth |
13,036 |
2,564 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
6,308 |
6,082 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,346 |
7,010 |
$92K |
| D0274 |
Bitewings - four radiographic images |
4,514 |
4,330 |
$92K |
| D1353 |
|
6,643 |
1,194 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,668 |
2,589 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
7,416 |
7,151 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,190 |
799 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,605 |
2,286 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
552 |
394 |
$33K |
| D1110 |
Prophylaxis - adult |
829 |
794 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
358 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
346 |
$18K |
| D0272 |
Bitewings - two radiographic images |
920 |
881 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
262 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
396 |
396 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
300 |
$9K |
| D0240 |
|
794 |
465 |
$8K |
| D0330 |
Panoramic radiographic image |
237 |
233 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
194 |
194 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
145 |
$3K |
| D1999 |
|
1,536 |
1,384 |
$2K |
| D3120 |
|
63 |
58 |
$1K |
| D1330 |
|
3,380 |
3,260 |
$0.00 |
| D0350 |
|
17 |
17 |
$0.00 |