| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
40,343 |
40,342 |
$1.36M |
| D0120 |
Periodic oral evaluation - established patient |
49,854 |
49,854 |
$1.11M |
| D1206 |
Topical application of fluoride varnish |
59,108 |
59,107 |
$938K |
| D1110 |
Prophylaxis - adult |
18,974 |
18,974 |
$908K |
| D0272 |
Bitewings - two radiographic images |
33,490 |
33,490 |
$609K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,596 |
4,329 |
$553K |
| D0274 |
Bitewings - four radiographic images |
13,896 |
13,896 |
$365K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,101 |
11,307 |
$364K |
| D0330 |
Panoramic radiographic image |
7,610 |
7,610 |
$318K |
| D1351 |
Sealant - per tooth |
10,019 |
2,577 |
$285K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,106 |
6,105 |
$253K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,120 |
1,820 |
$170K |
| D7240 |
Removal of impacted tooth - completely bony |
438 |
130 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,030 |
604 |
$100K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,562 |
1,562 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
3,773 |
3,736 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
971 |
969 |
$36K |
| D9222 |
|
276 |
276 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
237 |
91 |
$30K |
| D0160 |
|
153 |
153 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
105 |
105 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
331 |
154 |
$3K |
| D1354 |
|
16 |
12 |
$160.00 |